ArticleTrauma surgery & acute care open2026
Role of thromboelastography in risk stratifying patients with traumatic brain injury on prehospital antiplatelet agents.
Article in Trauma surgery & acute care open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: The Brain Injury Guidelines (BIG) offer valuable criteria for identifying trauma patients requiring observation without immediate intervention. One variable evaluated in BIG is prehospital aspirin (ASA) or clopidogrel use. These patients are classified as BIG3 requiring repeat head CT and neurosurgery consultation. This study aims to investigate the rate of hemorrhage progression and neurosurgery intervention (NSI) in patients fulfilling all BIG1 criteria except prehospital ASA or clopidogrel use and how thromboelastography (TEG) with platelet mapping (PM) could be used to identify patients whose platelets remain uninhibited by prehospital antiplatelet therapy, suggesting safe BIG 1 management. Methods: Retrospective review of data at a Level I trauma center between 2017 and 2022 focused on patients with traumatic brain injury (TBI) who reported prehospital ASA or clopidogrel use. Patients were categorized BIG 1, 2, or 3 based on initial CT, Glasgow Coma Scale admission, intoxication, skull fracture type, and presence/size of intracranial hemorrhages. Impact of antiplatelet agents on platelet function was analyzed using TEG with PM. Results: We identified 236 blunt TBIs on prehospital ASA or clopidogrel. BIG scores, excluding antiplatelet medications, resulted in BIG1 (24.6%), BIG2 (19.5%), and BIG3 (55.9%) classifications. 32% of patients on prehospital clopidogrel showed ADP inhibition greater than 60%, whereas 61% of those on prehospital ASA had arachidonic acid inhibition greater than 60%. Of the 58 cases fulfilling BIG1 criteria in all parameters except prehospital ASA or clopidogrel use, all but one patient demonstrated a stable repeat head CT, and no NSI was required. Discussion: Prehospital ASA or clopidogrel use did not impact hemorrhage progression or need for NSI in patients with blunt TBI otherwise meeting BIG1 criteria. TEG with PM provided valuable insights into platelet inhibition. Findings indicate the benefits of tailoring management strategies for trauma patients on antiplatelet therapy to optimize resource allocation and improve care. Level of evidence: IV therapeutic/care management.
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