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Master Thesis

Intérêts du Multiplate® dans la gestion des hémorragies intracrâniennes du patient traité par agents antiplaquettaires

Abstract : Antiplatelet therapy are widely used for prevention of cardiovascular related morbidity. APT is associated with greater risk of intracranial hemorrhage (ICH) after head trauma, also in bleeding progression in traumatic or spontaneous ICH. Platelet transfusion is the only therapeutic option for severe bleeding but its benefit remains controversial. Around 30% of treated patients are resistant to their APT. Multiplate® allows assessment of APT effectiveness. A normal Multiplate® questions the responsibility of APT in the hemorrhage and thus the benefit of platelet transfusion. The aim was to demonstrate that using Multiplate® for patients on APT with ICH requiring urgent neurosurgical procedure reduced platelet transfusion. Methods: his was a retrospective, observational study. All adults on APT with ICH requiring urgent neurosurgical procedure were included. They all had a Multiplate® to assess platelet function. We estimated that platelet transfusion reduction would correlate with APT non responsive rate in general population, approximately 30%. Surgical patients were compared according to their transfused or non-transfused status and safety of this targeted transfusion strategy was validated with patient’s outcome including occurrence of a bleeding complication. A logistic regression was performed to identify potential factors associated with hemorrhagic complication. Results: over the 2 years study period, 77 patients on APT with ICH, underwent urgent neurosurgical procedure. Among these patients, platelet transfusion saving was possible for 21 patients (27.2%) due to an ineffective APT. This results is in accordance to our hypothesis of approximately 30% transfusion reduction. Occurrence of bleeding complication, hospital length of stay and in-hospital mortality were similar in the transfused and non-transfused group. Conclusion: a targeted transfusion strategy using Multiplate® has reduced platelet use in nearly one-third of patients on APT admitted for I CH and requiring urgent neurosurgical intervention. This strategy is safe for patients and reflects current guidelines that aim to optimize APT neutralization.
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Submitted on : Wednesday, October 21, 2020 - 2:16:41 PM
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Hendrik Willemse. Intérêts du Multiplate® dans la gestion des hémorragies intracrâniennes du patient traité par agents antiplaquettaires. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02973954⟩

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