Regular aspirin-use preceeding the onset of primary ↑ Saloheimo P, Ahonen M, Juvela S, et.al.The effects of clopidogrel on elderly traumatic brain injured patients. Effects of antiplatelet agents on outcomes for elderly patients with Anticoagulant reversal for life-threatening bleeds.Ticagrelor does not likely respond to platelet transfusion reversal.Conjugated estrogens IV 0.6mg/kg/d for 5 days.Chronic renal failure patients may benefit from:.However, effects only last up to 24 hrs, and tachyphylaxis limits efficacy repeated doses.No transfusion complications of cryoprecipitate.Similar MOA to cryoprecipitate (increase factor VIII, vWF).0.3 mcg/kg/dose in 50 cc NS over 30 min.Consider significantly more platelets for those who were loaded with clopidogrel within the last week.At least 5 units of platelets initially to reverse routine antiplatelet doses.Limited evidence to support mortality improvement in reversal, but little evidence of harm.Reversal with combination of platelet transfusion, desmopressin.If time permits, obtain initial platelet function assay for aspirin and clopidogrel.If 350mg loading dose, platelet inhibition occurs within 2-5 hrs.When starting clopidogrel, takes 7 days to achieve max platelet inhibition. Takes 10 days for clopidogrel (life-span of a platelet).Delayed ICH defined as traumatic ICH within 2 weeks after initial normal CTH.However, no patients on clopidogrel had delayed ICH compared to ~1% pts on warfarin with delayed ICH.May be confounded by patients on warfarin having low threshold for presenting with head injury to ED, but highlights high frequency of bleeds in patients on clopidogrel.Prevalence of immediate traumatic ICH in pts on clopidogrel 12% compared to 5% on warfarin.Excluded SDH, epidural hemorrhage, aneurysm, AVM, surgical evacuation of ICH within 24 hrs, thrombocytopenia 2-3, infratentorial hematomas, large intraventricular hemorrhage.Included patients with at least 7 days of antiplatelet therapy, including ASA, clopidogrel, dipyridamole.2.05 OR, increased odds of death at 3 months in platelet transfusion group.PATCH trial in 2016 suggested mortality is higher in platelet transfused patients, alongside several other preceding studies.Aspirin alone is predictor of higher mortality in spontaneous ICH.Significantly higher mortality with either clopidogrel mono or dual-antiplatelet treatment in trauma patients.Risk of mortality from ICH on warfarin ~16-80%.Consider reversal of aspirin and clopidogrel in acute life threatening hemorrhage, but it is very controversial in ICH.
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