Multiple electrode aggregometry in antiplatelet-related intracerebral haemorrhage

As the population ages, antiplatelet agents are increasingly used in patients with cardiovascular diseases. Due to impaired platelet activity, these patients are at increased risk for bleeding complications and this is of particular importance in patients with intracerebral haemorrhage. The multiple electrode aggregometry analyser Multiplate (Roche Diagnostics, Mannheim, Germany) was introduced in 2006 to monitor the effectiveness of antiplatelet drugs in interventional cardiology. As a point-of-care device, it allows bedside assessment of platelet activity within minutes through analysis of a sample of whole blood. In patients treated with antiplatelet medication and in need of urgent cardiac surgery, these devices allow prediction of intraoperative blood loss and their use was implemented within respective guidelines to direct transfusion strategies. We used the Multiplate analyser for rapid assessment of antiplatelet activity in a patient who developed an intracerebral haemorrhage after administration of aspirin and clopidogrel. Antiplatelet activity was assessed within 10 minutes while the patient was transferred to the operating room and after transfusion of platelet concentrates and administration of desmopressin and tranexamic acid, repeated Multiplate analysis demonstrated nearly normalized platelet activity. In our view, there is great potential for this device to improve treatment in neurosurgery and especially the treatment of antiplatelet-related intracerebral haemorrhage. Instant assessment of antiplatelet activity or effectiveness of haemostatic measures is facilitated and furthermore, patients with normal platelet activity despite a positive history of antiplatelet medication intake can be identified. In these patients, empiric administration of haemostatic substances would unnecessarily increase the risk of thromboembolic events.