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PRU assays, 7% of patients taking any aspirin, and 27% of patients

taking clopidogrel were not therapeutic, respectively. After plate-

let transfusion, 47% of patients on any aspirin and 49% of pa-

tients on any clopidogrel failed to be reversed. The ARU increased

by 71

76 per unit of platelets, and the PRU increased by 48

46 per

unit of platelets. This study provides a means for detecting pa-

tients reported to be on antiplatelet agents whom have function-

ing platelets and receive unnecessary transfusions following a TBI.

In addition, a single platelet transfusion may not be sufficient to

reverse platelet inhibition in patients who are therapeutic on their

antiplatelet therapy. The aspirin and P2Y12 response unit assays

have utility in the TBI population and require prospective evalua-

tion as tools for determining whether to transfuse platelets in TBI

patients.

Keywords: platelet, aspirin, platelet reactivity, platelet transfusion,

clopidogrel

C3-06

TRANSFUSION REVERSAL OF PRE-MORBID ORAL AS-

PIRIN USE IS NOT PROTECTIVE AGAINST RADIO-

GRAPHIC PROGRESSION OF INTRACRANIAL

PATHOLOGY

Joshua Bauer

1

, Phillip Choi

1

, Benjamin Zusman

1

, David

Panczykowski

2

, Phillip Parry

2

, Ava Puccio

1

, David Okonkwo

1,2

1

University of Pittsburgh School of Medicine, Neurosurgery, Pitts-

burgh, USA

2

UPMC, Neurosurgery, Pittsburgh, USA

There remains controversy for reversal of antiplatelet agents in

traumatic brain injury (TBI) patients. The purpose of this study is to

longitudinally evaluate the effect transfusion reversal of antiplatelet

agents has on radiographic progression of intracranial pathology. A

prospective comparative analysis of TBI patients (

>

65 years) with

evidence of intracranial pathology on computed tomography (CT)

scan was conducted at our institution from June 2013-Janurary 2015.

We assessed baseline demographics, coagulation parameters, plate-

let dysfunction using a platelet function assay for aspirin (Ver-

ifyNow), transfusion management, and clinical course. The primary

endpoint was radiographic progression of intracranial injury defined

as expansion of admission pathology using the components ABC/2

method for measuring intracranial lesion. Descriptive data were

stratified by having a therapeutic platelet function assay for aspirin

on admission, and analyzed via Chi-square test. A total of 96 patients

suffering TBI with radiographic intracranial injury and aspirin use

were assessed; 86% (83) therapeutic vs 14% (13) sub-therapeutic on

aspirin. A logistic regression analysis was performed to compare

groups and identify predictors of radiographic progression. Covari-

ates included: age, admission Glasgow coma score (GCS), and

baseline Rotterdam scores for CT scan severity. Subgroup multi-

variate analysis of only those with a therapeutic aspirin response did

not demonstrate a significantly different rate of progression in either

those being transfused, or those achieving non-therapeutic status

post-transfusion (OR

=

4.19 (1.37–12.8), p

=

0.01). Transfusion re-

versal of aspirin use was not protective against radiographic pro-

gression of intracranial hemorrhage. This data refutes the reflexive

transfusion of patients on antiplatelet therapy as a means for thera-

peutic intervention of aspirin use. Given the latter, the evidence fully

supports the need for a randomized clinical trial aimed at identifying

an algorithm for platelet transfusion in a subgroup of patients within

the TBI population.

Keywords: AntiPlatelets, Transfusions, Hemorrhage Progression

C3-07

INSIGHTS FROM HIGH FREQUENCY INTRACRANIAL

PRESSURE DATA: A TREATMENT THRESHOLD BELOW

20MMHG MAY BE MORE APPROPRIATE

Gregory Hawryluk

1,2

, Lara Zimmerman

3

, Rajiv Saigal

2

, Adam

Ferguson

2

, Ding Quan

4

, Geoffrey Manley

2

1

University of Utah, Neurosurgery, Salt Lake City, USA

2

University of California, San Francisco, Neurosurgery, San Fran-

cisco, USA

3

University of California, Los Angeles, Neurosurgery, Los Angeles,

USA

4

University of California, San Francisco, Physiological Nursing, San

Francisco, USA

Introduction:

Intracranial pressure (ICP) elevation is a compartment

syndrome which impairs the flow of blood to the brain. The precise

intracranial threshold at which brain injury begins to occur remains

uncertain.

Methods:

A computer system automatically collected and stored q1

minute physiological data from ICU patients over a 6 y period. Data

for 516 patients who underwent ICP monitoring was collected, 372 of

whom had a traumatic brain injury; outcome data (GOS) was avail-

able for all but 19. Mean ICP was calculated for epochs up to 30d

from the start of intensive care. The proportion of ICP values above

thresholds from 1 mmHg to 80 mmHg in were calculated in 1 mmHg

increments for these same epochs. The relationship between these

measures and outcome was explored. A complementary principal

component analysis (PCA) was used to explore physiologic changes at

various ICP thresholds.

Results:

A total of 4,090,964 q1 minute ICP measurements were

recorded for the included patients (7.78 patient years of recordings).

8.9% and 3.7% were above 20 and 25 mmHg respectively. Mean ICP

values correlated with outcome for 14d after admission. ICP values

below 20 mmHg were associated with outcome and time spent above

ICPs from 17 to 19 seemed most strongly associated with outcome.

The PCA suggested physiologic changes above intracranial pressures

of 19 mmHg and 24 mmHg.

Conclusions:

This study provides strong evidence supporting a cor-

relation between ICP values and outcome but does not provide evidence

of a causal relationship. It suggests that ICP values below 20mmHg may

be harmful and that ICP might best be kept lower than 19mmHg.

Keywords: treatment threshold, high frequency, physiology, neu-

romonitoring

C3-08

PATIENTS WITH SPINAL CORD INJURIES FAVOR AD-

MINISTRATION OF METHYLPREDNISOLONE BUT HAVE

LITTLE INPUT INTO ITS ADMINISTRATION

Christian Bowers

1

, Jeffrey Rosenbluth

2

,

Gregory Hawryluk

1

1

University of Utah, Neurosurgery, Salt Lake City, USA

2

University of Utah, Physical Medicine and Rehabilitation, Salt Lake

City, USA

Object:

The use of methylprednisolone sodium succinate (MPSS) for

acute spinal cord injury (SCI) is associated with small functional

benefits and elevated risk of adverse events. We sought to learn the

opinions and preferences of SCI patients regarding MPSS as well as

their involvement in the decision to administer MPSS.

Methods:

27 SCI experts adjudicated a document summarizing

the literature regarding MPSS use in acute SCI. They rated it neutral,

A-82