Comparative Efficacy of Plateletpheresis and Rehydration for Managing Secondary Thrombocytosis in the Neurosurgical Intensive Care Unit

Secondary thrombocytosis (ST) is associated with increased thromboembolic risk in neurocritical care settings; however, its optimal management remains a subject of debate. We aimed to compare the therapeutic efficacy and clinical outcomes of plateletpheresis versus rehydration therapy in patients with ST. A retrospective cohort study was conducted in the Neurosurgical Intensive Care Unit (NSICU) of XX from April 2020 to July 2024. A total of 68 patients with ST were enrolled and allocated to the plateletpheresis group (n=31) or the rehydration group (n=37). The primary endpoints were changes in complete blood count parameters. Secondary outcomes included NSICU and total hospital length of stay, hospitalization costs, and 3-month modified Rankin Scale scores. Both interventions demonstrated significant efficacy in managing ST. Plateletpheresis yielded superior cytoreductive effects, with greater reductions in platelet count (64% vs. 55%; P<0.001) and plateletcrit (65% vs. 55%; P<0.001) compared to rehydration. In contrast, rehydration produced nonspecific hematological effects, notably a significant decrease in leukocyte subpopulations-neutrophils (55% vs. 25%) and monocytes (50% vs. 17%) (P<0.001). Clinically, plateletpheresis was associated with lower treatment cycles, shorter NSICU and hospital stays, as well as reduced hospitalization costs. Functional outcomes at 3 months were comparable between the groups. Plateletpheresis appears to be the preferred therapeutic approach for rapid platelet reduction in neurocritical patients with ST, offering targeted cytoreduction, a favorable safety profile, and improved resource efficiency. Further validation through multicenter randomized controlled trials is warranted.