Hemorrhagic Complications of External Ventriculostomy in the Aspirin and P2Y12 Response Assay Era

Authors

Neil Majmundar, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.Follow
Christina Sarris, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Darshan Shastri, Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA.
Joseph Doran, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Chirag Gandhi, Department of Neurosurgery, Westchester Medical Center at NY Medical College, Valhalla, New York, USA.
Rachid Assina, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address: assinara@njms.rutgers.edu.

Document Type

Article

Abstract

OBJECTIVE: Hemorrhagic complications reported from external ventricular drain (EVD) placement range from 10% to 44%. There remains limited literature investigating the incidence, risk factors, and mechanisms to prevent its occurrence, especially in the setting of antiplatelet agent use. We investigated EVD-related hemorrhagic complications after the implementation of VerifyNow platelet inhibition assays at our institution. METHODS: Medical records from 445 patients requiring EVD placement during a 2-year period during which our institution used the assays were reviewed. In total 345 patients were included, and 208 of them underwent assay testing. Indications for EVD included complications of cerebrovascular disease (n = 215), traumatic brain injury (n = 74), primary hydrocephalus (n = 23), and tumor (n = 33). Hemorrhage was defined as any new area of hyperdensity adjacent to or immediately along the catheter trajectory on computed tomography. RESULTS: There was no significant decrease in catheter-induced hemorrhage (CIH) between patients who underwent the VerifyNow assay and those who did not. Platelet transfusion did not significantly decrease the risk of CIH. CIH occurred in 17.7% of patients, significantly decreased when compared with our previously published incidence of 33% before platelet inhibition assay use (P < 0.05). Patients with cerebrovascular disease complications exhibited a significant decrease in CIH, 20% versus 39%, before assay use (P < 0.01). CONCLUSIONS: The incidence of hemorrhage is lower in our new cohort when compared with that of our previously published cohort. Despite the overall decreased rate of hemorrhage, there was no significant difference in hemorrhage rates between patients who did or did not undergo the assay. Platelet transfusion did not decrease the incidence of hemorrhage in patients with inhibited platelet function.

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal (adverse effects, blood, therapeutic use); Aspirin (adverse effects, blood, therapeutic use); Cerebral Hemorrhage (blood, chemically induced, diagnosis); Cohort Studies; Female; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors (adverse effects, blood, therapeutic use); Platelet Transfusion (methods, trends); Purinergic P2Y Receptor Antagonists (adverse effects, blood, therapeutic use); Retrospective Studies; Ventriculostomy (methods, trends); Young Adult

Publication Date

2-1-2019

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

122

First Page

e961

Last Page

e968

PubMed ID

30439521

Digital Object Identifier (DOI)

10.1016/j.wneu.2018.10.181

Recommended Citation

Majmundar, Neil; Sarris, Christina; Shastri, Darshan; Doran, Joseph; Gandhi, Chirag; and Assina, Rachid, "Hemorrhagic Complications of External Ventriculostomy in the Aspirin and P2Y12 Response Assay Era" (2019). Neurosurgery. 2201.
https://scholar.barrowneuro.org/neurosurgery/2201