Handling platelet transfusions requests for patients with intracranial bleeds who are on Plavix®

A Blood Bank physician from northern New England asks the following:

How are other colleagues handling platelet transfusions requests for patients with intracranial bleeds who are on Plavix®? The dilemma is that our neurosurgery colleagues would like the platelet counts to be above 100,000 for intracranial bleeds or prior to an invasive neurosurgical procedure. With Plavix® in the background, the patient's platelet count is not meaningful, so many doses of platelets are requested (at least two does of apheresis platelets and frequently more). It is not clear what is a sufficient number of doses. Has anyone been successful in developing a transfusion strategy for this type of bleeding without the use of platelet-aggregometry assays?

There are Plavix®-sensitive rapid platelet function assays now available, has anyone been successful in using these assays in developing an algorithm that was found acceptable to their group?

Advice from other colleagues would be greatly appreciated.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator