Article
Impaired platelet function may prevent delayed cerebral ischemia after aneurysmal subarachnoid haemorrhage – the multi-centre PlaFuSAH study
Eine beeinträchtigte Plättchenfunktion schützt vor verspäteter zerebraler Ischämie nach aneurysmatischer Subarachnoidalblutung – die Resultate der multizentrischen PlaFuSah Studie
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Published: | June 26, 2020 |
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Objective: Platelets are implicated in delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (SAH) via microthrombosis, inflammation and vasoconstriction. However, it is unknown whether intact platelet function favours the occurrence of DCI. The aim of this study was to evaluate in-vitro platelet function and its association with DCI and neurological outcome after aneurysmal SAH.
Methods: In this prospective observational study, six German neurosurgical centers recruited patients with SAH. Peripheral venous blood was drawn upon admission and at multiple time points to assess platelet function using the platelet-function-analyser test (PFA). Prolonged PFA (Collagen/Epinephrin: >160 sec.; Collagen/ADP: >121 sec) indicates impaired platelet function. Based on PFA at admission, patients were divided into two groups: Normal versus prolonged PFA. Outcome variables included DCI, modified Rankin scale (mRS) at discharge and case fatality. Statistical analysis was performed using multivariate binary logistic regression.
Results: The study population consisted of 171 patients with a mean age of 56.6±12 years, 31.6% of which were male. High grade SAH (WFNS score≥3) was recorded in 45.6%. The overall rate of DCI was 39.2%. Admission PFA was prolonged in 49.1% of patients. In the patient cohort with normal PFA values, DCI occurred in 45 patients (49.5%), compared to 22 patients (27.5%) in the group with prolonged PFA. Patients with prolonged PFA had a lower rate of DCI compared to patients with normal PFA (OR = 0.49; 95% CI 0.25, 0.97; p-value=0.04). While poor outcome was less likely in the group with prolonged PFA (OR 0.41; 95% CI 0.17, 0.99, p-value=0.05), there was no association with case fatality (OR 0.31; 95% CI 0.07, 1.38; p-value=0.13).
Conclusion: Our multicenter study found a significant association between in-vitro platelet function and the rate of DCI. Normal platelet function predisposed to a two-fold higher risk of developing DCI. This observation also appeared to translate into favorable clinical outcome.