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• W4313222561 abstract "Introduction: While the role of desmopressin (DDAVP) is unclear in patients with antiplatelet-associated intracerebral hemorrhage (ICH), platelet transfusions are recommended perioperatively. Thromboelastography with platelet mapping (TEG-PM) may identify patients who benefit from both interventions regardless of surgery. This study was conducted to assess use of TEG-PM in this setting. Methods: This was a single-centered pre-post study, divided into a pre-algorithm (May 01, 2020 – May 01, 2021) and post-algorithm period (September 02, 2021 – March 31, 2022). Adult patients taking one or more antiplatelet agents who were admitted to the intensive care unit (ICU) for antiplatelet-associated major bleeding were included. Patients were excluded if they received therapeutic anticoagulation. An optional TEG-PM protocol was introduced at the start of the post-algorithm period that recommended platelet transfusions and DDAVP based on TEG-PM values. The primary outcome of the study was the difference in utilization of platelet transfusions and DDAVP between groups. Clinical endpoints were assessed secondarily. Results: Ninety-one patients were included in the pre-algorithm group and 68 patients in the post-algorithm group. The median age was 76 years and 58% of patients were male. Approximately 69% of patients received aspirin while 18% received dual antiplatelet therapy. In the post-algorithm group, full or partial protocol adherence occurred in 44 patients (63.2%). In those with a baseline and repeat TEG-PM, there was improvement in the AA and ADP percent inhibition (37.1% and 1.8% decrease, respectively). While the utilization of platelet transfusions did not differ between groups (67% vs 61.8%, p=0.49), the use of DDAVP was significantly higher in the post-algorithm group (24% vs 66%, p< 0.001) as was the dosing of DDAVP (0.32 mcg/kg [0.3 – 0.4 mcg/kg] vs 0.4 mcg/kg [0.33 – 0.4 mcg/kg], p=0.02). There was no difference in hemostatic efficacy (79.1% vs 75%, p=0.73), rebleeding (19.8% vs 11.8%, p=0.26), or mortality (20.9% vs 17.6%, p=0.61). There was no difference in safety. Conclusions: Using TEG-PM for the management of antiplatelet-associated major bleeding in ICU patients resulted in higher utilization and dosing of DDAVP without any impact on clinical outcomes." @default.
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• W4313222561 date "2022-12-15" @default.
• W4313222561 modified "2023-10-01" @default.
• W4313222561 title "511: USE OF THROMBOELASTOGRAPHY WITH PLATELET MAPPING FOR MANAGEMENT OF ANTIPLATELET-ASSOCIATED BLEEDING" @default.
• W4313222561 doi "https://doi.org/10.1097/01.ccm.0000907772.89043.b0" @default.
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