Comparative Efficacy of Plateletpheresis and Rehydration for Managing Secondary Thrombocytosis in the Neurosurgical Intensive Care Unit

• Published in: World neurosurgery Vol. 202; p. 124380
• Main Authors: Yu, Zuan, Tao, Yuqi, Zhu, Mingfeng, Yu, Tao, Liang, Risheng
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2025
• Subjects: Neurocritical care; Neurosurgery; Plateletpheresis; Rehydration; Secondary thrombocytosis; PCT; ST; PDW; NSICU; Neurocritical care; ICH; mRS; MPV; Plateletpheresis; GCS; Rehydration; PLT; Hb; TBI; Secondary thrombocytosis; Traumatic brain injury; Plateletcrit; Mean platelet volume; Glasgow Coma Scale; Modified Rankin Scale; Hemoglobin; Neurosurgical intensive care unit; Platelet distribution width; Intracerebral hemorrhage; Platelet
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2025.124380

Secondary thrombocytosis (ST) is associated with increased thromboembolic risk in neurocritical care settings; however, its optimal management remains a subject of debate. We aimed to compare the therapeutic efficacy and clinical outcomes of plateletpheresis versus rehydration therapy in patients with ST. A retrospective cohort study was conducted in the neurosurgical intensive care unit (NSICU) of the First Affiliated Hospital of Wannan Medical College from April 2020 to July 2024. A total of 68 patients with ST were enrolled and allocated to the plateletpheresis group (n = 31) or the rehydration group (n = 37). The primary endpoints were changes in complete blood count parameters. Secondary outcomes included NSICU and total hospital length of stay, hospitalization costs, and 3-month modified Rankin Scale scores. Both interventions demonstrated significant efficacy in managing ST. Plateletpheresis yielded superior cytoreductive effects, with greater reductions in platelet count (64% vs. 55%; P < 0.001) and plateletcrit (65% vs. 55%; P < 0.001) compared to rehydration. In contrast, rehydration produced nonspecific hematological effects, notably a significant decrease in leukocyte subpopulations—neutrophils (55% vs. 25%) and monocytes (50% vs. 17%) (P < 0.001). Clinically, plateletpheresis was associated with lower treatment cycles, shorter NSICU and hospital stays, as well as reduced hospitalization costs. Functional outcomes at 3 months were comparable between the groups. Plateletpheresis appears to be the preferred therapeutic approach for rapid platelet reduction in neurocritical patients with ST, offering targeted cytoreduction, a favorable safety profile, and improved resource efficiency. Further validation through multicenter randomized controlled trials is warranted.