Key result
Point-of-care platelet function testing in emergency neurosurgery for intracranial hemorrhage reduced bleeding events and length of hospitalization, but did not improve blood product use.
Why the study?
Rapid preoperative identification of bleeding diathesis is needed to guide transfusions in neurosurgery for ICH, but point-of-care platelet function testing has not been extensively evaluated in this setting.
Does point-of-care platelet function testing reduce perioperative blood product transfusion and improve outcomes in adult patients undergoing neurosurgery for intracranial hemorrhage?
Systematic Review (n=849)
Does point-of-care platelet function testing reduce perioperative blood product transfusion and improve outcomes in adult patients undergoing neurosurgery for intracranial hemorrhage?
Point-of-care platelet function testing in emergency neurosurgery for intracranial hemorrhage may reduce bleeding events and length of stay, but current evidence is insufficient to confirm improvements in mortality or functional outcomes.
May warrant point-of-care testing in emergency ICH neurosurgery to reduce bleeding and stay; extends evidence while leaving transfusion impact unresolved.
Given the rising prevalence of antiplatelet therapy, rapid preoperative identification of patients with bleeding diathesis is necessary for the guidance of blood product administration. This is especially relevant in neurosurgery for intracranial hemorrhage (ICH), where indiscriminate transfusions may lead to further hemorrhagic or thromboembolic injury. Point-of-care (POC) testing of platelet function is a promising solution to this dilemma, as it has been proven effective in cardiac surgery. However, to date, POC platelet function testing in neurosurgery has not been extensively evaluated. This systematic review appraises the use of POC platelet function test (PFT) in emergency neurosurgery in terms of its impact on patient outcomes. A comprehensive search was conducted on four electronic databases (Pubmed, MEDLINE, Embase, and Cochrane) for relevant English language articles from their respective inceptions until 1 June 2022. We included all randomized controlled trials and cohort studies that met the following inclusion criteria: (i) involved adult patients undergoing neurosurgery for ICH; (ii) evaluated platelet function via POC PFT; (iii) reported a change in perioperative blood loss; and/or (iv) reported data on treatment-related adverse events and mortality. Assessment of study quality was conducted using the Newcastle Ottawa Quality Assessment Scale for Cohort Studies and Case-Control Studies, and the JBI Critical Appraisal Checklist for Case Series. The search yielded 2,835 studies, of which seven observational studies comprising 849 patients met the inclusion criteria for this review. Overall, there is evidence that the use of POC PFT to assess bleeding risk reduced bleeding events, thromboembolic adverse outcomes, and the length of hospitalization. However, there is currently insufficient evidence to suggest that using POC PFT improves blood product use, functional outcomes or mortality.
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Xu et al. (2022) conducted a systematic review in Intracranial hemorrhage requiring emergency neurosurgery (n=849). Point-of-care platelet function testing (POC PFT) vs. Standard coagulation tests (SCT) or no POC PFT was evaluated on Frequency of perioperative transfusion of blood products. Point-of-care platelet function testing in emergency neurosurgery for intracranial hemorrhage reduced bleeding events and length of hospitalization, but did not improve blood product use.
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