Godier and colleagues describe a patient on dual antiplatelet therapy with ticagrelor and aspirin due to two bare metal stents that arrives in the ED with a non-haemorrhagic stroke. The patient receives thrombolysis and develops intracranial haematoma with intraventricular haemorrhage requiring an external ventricular drain. Platelet aggregation in whole blood evaluated by VerifyNow before surgery showed good pharmacodynamic response to aspirin and ticagrelor.

The patient received 8 units of platelets which reversed the effect of aspirin but had no effect on the ADP receptor inhibition which was maintained also after transfusion of additionally 9 units of platelets preoperatively. The patient developed a large intracranial haemorrhage and died shortly after surgery.

This report indicates that platelet transfusion alone not is sufficient to reverse the effect of ticagrelor in patients undergoing neurosurgery.

– Pär Johansson

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