scholarly journals Antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries

2020 ◽  
Vol 5 (1) ◽  
pp. e000520
Author(s):  
Scott M Alter ◽  
Benjamin A Mazer ◽  
Joshua J Solano ◽  
Richard D Shih ◽  
Mary J Hughes ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Injury Severity ◽  
Head Injuries ◽  
Antiplatelet Agents ◽  
High Rate ◽  
Head Ct ◽  
Severity Scores ◽  
Blunt Head Trauma

BackgroundAntiplatelet agents are increasingly used in cardiovascular treatment. Limited research has been performed into risks of acute and delayed traumatic intracranial hemorrhage (ICH) in these patients who sustain head injuries. Our goal was to assess the overall odds and identify factors associated with ICH in patients on antiplatelet therapy.MethodsA retrospective observational study was conducted at two level I trauma centers. Adult patients with head injuries on antiplatelet agents were enrolled from the hospitals’ trauma registries. Acute ICH was diagnosed by head CT. Observation and repeat CT to evaluate for delayed ICH was performed at clinicians’ discretion. Patients were stratified by antiplatelet type and analyzed by ICH outcome.ResultsOf 327 patients on antiplatelets who presented with blunt head trauma, 133 (40.7%) had acute ICH. Three (0.9%) had delayed ICH on repeat CT, were asymptomatic and did not require neurosurgical intervention. One with delayed ICH was on clopidogrel and two were on both clopidogrel and aspirin. Patients with delayed ICH compared with no ICH were older (94 vs 74 years) with higher injury severity scores (15.7 vs 4.4) and trended towards lower platelet counts (141 vs 216). Patients on aspirin had a higher acute ICH rate compared with patients on P2Y12 inhibitors (48% vs 30%, 18% difference, 95% CI 4 to 33; OR 2.18, 95% CI 1.15 to 4.13). No other group comparison had significant differences in ICH rate.ConclusionsPatients on antiplatelet agents with head trauma have a high rate of ICH. Routine head CT is recommended. Patients infrequently developed delayed ICH. Routine repeat CT imaging does not appear to be necessary for all patients.Level of evidenceLevel III, prognostic.

Outcomes in Traumatic Brain Injury for Patients Presenting on Antiplatelet Therapy

2015 ◽  
Vol 81 (2) ◽  
pp. 128-132 ◽  
Author(s):  
John David Cull ◽  
Lauren M. Sakai ◽  
Imran Sabir ◽  
Brent Johnson ◽  
Andrew Tully ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Antiplatelet Therapy ◽  
Injury Severity ◽  
Head Injuries ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Number Of Patients ◽  
Blunt Head Trauma ◽  
Significant Difference

An increasing number of patients are presenting to trauma units with head injuries on antiplatelet therapy (APT). The influence of APTon these patients is poorly defined. This study examines the outcomes of patients on APT presenting to the hospital with blunt head trauma (BHT). Registries of two Level I trauma centers were reviewed for patients older than 40 years of age from January 2008 to December 2011 with BHT. Patients on APT were compared with control subjects. Primary outcome measures were in-hospital mortality, intracranial hemorrhage (ICH), and need for neurosurgical intervention (NI). Hospital length of stay (LOS) was a secondary outcome measure. Multivariate analysis was used and adjusted models included antiplatelet status, age, Injury Severity Score (ISS), and Glasgow coma scale (GCS). Patients meeting inclusion criteria and having complete data (n = 1547) were included in the analysis; 422 (27%) patients were taking APT. Rates of ICH, NI, and in-hospital mortality of patients with BHT in our study were 45.4, 3.1, and 5.8 per cent, respectively. Controlling for age, ISS, and GCS, there was no significant difference in ICH (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.61 to 1.16), NI (OR, 1.26; 95% CI, 0.60 to 2.67), or mortality (OR, 1.79; 95% CI, 0.89 to 3.59) associated with APT. Subgroup analysis revealed that patients with ISS 20 or greater on APT had increased in-hospital mortality (OR, 2.34; 95% CI, 1.03 to 5.31). LOS greater than 14 days was more likely in the APT group than those in the non-APT group (OR, 1.85; 95% CI, 1.09 to 3.12). The effects of antiplatelet therapy in patients with BHT aged 40 years and older showed no difference in ICH, NI, and in-hospital mortality.

scholarly journals Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 308 ◽  
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Sabino Luzzi ◽  
Cristian Gragnaniello ◽  
Alice Giotta Lucifero ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Mortality Rates ◽  
Control Group ◽  
Number Of Patients ◽  
Blunt Head Trauma ◽  
Significant Difference

Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery.

scholarly journals Incidence of Delayed Intracranial Hemorrhage in Older Patients After Blunt Head Trauma

JAMA Surgery ◽  
2018 ◽  
Vol 153 (6) ◽  
pp. 570 ◽  
Author(s):  
James A. Chenoweth ◽  
Samuel D. Gaona ◽  
Mark Faul ◽  
James F. Holmes ◽  
Daniel K. Nishijima ◽  
...  
Keyword(s):  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Older Patients ◽  
Blunt Head Trauma

Preinjury Antiplatelet Use Does Not Increase the Risk of Progression of Small Intracranial Hemorrhage

2020 ◽  
Vol 86 (8) ◽  
pp. 991-995
Author(s):  
Joshua D. Billings ◽  
Abid D. Khan ◽  
John H. McVicker ◽  
Thomas J. Schroeppel
Keyword(s):  
Brain Injury ◽  
Intracranial Hemorrhage ◽  
Injury Severity ◽  
Antiplatelet Agents ◽  
Outcome Data ◽  
Inclusion Criteria ◽  
Antiplatelet Medication ◽  
Risk Of Progression ◽  
Head Computed Tomography ◽  
Repeat Imaging

Background The modified brain injury guidelines (mBIG) provide an algorithm for surgeons to manage some mild traumatic brain injury (TBI) with intracranial hemorrhage (ICH) without neurosurgical consultation or repeat imaging. Currently, antiplatelet use among patients with any ICH classifies a patient at the highest level, mBIG 3. This study assesses the risk of clinical progression among patients taking antiplatelet medications with mild TBI with ICH. Methods A retrospective analysis of patients with traumatic ICH over a 5-year period was conducted. Demographics, injury severity, and outcome data were collected for each patient. Patients taking antiplatelet agents were reclassified as if they were not taking these medications. Patients who would have met criteria for a lower classification (mBIG 1 or 2) without antiplatelet agents were designated mBIG 3 Antiplatelet and compared with all other mBIG 1 and 2 patients. Results 736 patients met the inclusion criteria. 158 patients were taking antiplatelet medications and 53 were reclassified as mBIG 3 Antiplatelet. When comparing mBIG 3 Antiplatelet to the 226 patients originally classified as mBIG 1 and 2, mBIG 3 Antiplatelet patients were more likely to undergo repeat head computed tomography (98.1% vs 76.6%; P < .001) and neurosurgical consultation (94.2% vs 76.5%; P < .001) but had no significant differences in outcomes. No mBIG 3 Antiplatelet patients had a worsening examination or needed operative intervention. Discussion This data suggests that antiplatelet medication use should not automatically classify a patient as mBIG 3. Adoption of this strategy would better utilize resources and avoid unnecessary costs without sacrificing care.

Repeat Head CT? Not Necessary for Patients with a Negative Initial Head CT on Anticoagulation or Antiplatelet Therapy Suffering Low-Altitude Falls

2017 ◽  
Vol 83 (5) ◽  
pp. 429-435 ◽  
Author(s):  
Zachary M. Bauman ◽  
John M. Ruggero ◽  
Sunny Squindo ◽  
Chris Mceachin ◽  
Michelle Jaskot ◽  
...  
Keyword(s):  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Trauma Center ◽  
Statistical Significance ◽  
Close Monitoring ◽  
Trauma Centers ◽  
Head Ct ◽  
Level Ii ◽  
Low Altitude ◽  
Related Mortality

Anticoagulation and antiplatelet (ACAP) medications are increasingly prescribed to patients at high risk for falls. Many trauma centers have developed protocols for obtaining repeat head CT (HCT) for patients with low-altitude falls on ACAP therapy. We assess the need for routine scheduled repeat HCT in this population. Prospective, observational analysis of all low-altitude fall (<6 feet) patients on ACAP therapy evaluated at a Level II trauma center. All low-altitude fall patients with visible or suspected head trauma received an initial HCT. Patients were admitted and repeat HCT was obtained 12 hours later or earlier if acute neurologic decline developed. Chisquared, Fischer exact, t, and Wilcoxon rank-sum tests were used. Statistical significance was defined as P < 0.05. Total of 1501 patients enrolled suffering low-altitude falls with initial HCT. Among them 1379(91.2%) were negative and 122(8.1%) were initially positive for intracranial hemorrhage. Mean age was 79.9 ± 11.4 years, 61 per cent were female and 85 per cent had visible head trauma at presentation. One hundred ninety-nine were excluded secondary to not receiving repeat HCT. Of the 1180 patients with normal initial HCT who underwent repeat HCT, only 7 (0.51%) had delayed intracranial hemorrhage. None of these patients required surgery, major changes in medical management or suffered head trauma–related mortality; 69 per cent were taking aspirin (acetylsalicylic acid, ASA), 19 per cent warfarin, 17 per cent clopidogrel, 6 per cent other anticoagulants, and 11 per cent were on combination therapy. Repeat HCT for patients on any ACAP therapy after low-altitude fall with a negative initial HCT is not necessary. Thorough neurologic examination and close monitoring is as effective as obtaining a repeat HCT.

scholarly journals Prevalence of Intracranial Hemorrhage after Blunt Head Trauma in Patients on Pre-injury Dabigatran

2017 ◽  
Vol 18 (5) ◽  
pp. 794-799 ◽  
Author(s):  
James Chenoweth ◽  
Austin Johnson ◽  
Laura Shook ◽  
Mark Sutter ◽  
Daniel Nishijima ◽  
...  
Keyword(s):  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Blunt Head Trauma

The role of delayed head CT in evaluation of elderly blunt head trauma victims taking antithrombotic therapy

2017 ◽  
Vol 43 (6) ◽  
pp. 741-746 ◽  
Author(s):  
D. Scantling ◽  
C. Fischer ◽  
R. Gruner ◽  
A. Teichman ◽  
B. McCracken ◽  
...  
Keyword(s):  
Head Trauma ◽  
Antithrombotic Therapy ◽  
Head Ct ◽  
Blunt Head Trauma ◽  
Trauma Victims

Temporal Trends in the Use of Antiplatelet Therapy in Patients With Acute Coronary Syndromes

2017 ◽  
Vol 23 (1) ◽  
pp. 57-65 ◽  
Author(s):  
María Asunción Esteve-Pastor ◽  
Juan Miguel Ruíz-Nodar ◽  
Esteban Orenes-Piñero ◽  
José Miguel Rivera-Caravaca ◽  
Miriam Quintana-Giner ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Clinical Guidelines ◽  
Acute Coronary Syndromes ◽  
Temporal Trends ◽  
Antiplatelet Agent ◽  
Real Life ◽  
Antiplatelet Agents ◽  
High Rate ◽  
St Segment Elevation ◽  
Coronary Syndromes

Background: Current clinical guidelines of acute coronary syndromes (ACS) recommend the use of potent antiplatelet therapy, prasugrel or ticagrelor, because both drugs consistently reduce cardiovascular events. Purpose: The aim of this study was to examine temporal changes in the use of optimal antiplatelet therapy in patients with ACS. Methods: A total of 1717 consecutive patients admitted for ACS in 3 tertiary hospitals from February 2014 to December 2015 were enrolled. We divided these 23 months into 4 semesters: period I (0-5 months), period II (6-11 months), period III (12-17 months), and period IV (17-23 months). Demographic, clinical, and treatment data were collected both at admission and at discharge. Results: Treatment with clopidogrel remained constant throughout the periods (52%, 50%, 44%, and 50% for periods I, II, III, and IV, respectively), whereas a progressive increase in ticagrelor treatment was observed (15%, 25%, 26%, and 28%; P = .001). Indeed, new P2Y12 agents showed an increase from 47% at the first semester to 65% in patients with ST-segment elevation myocardial infarction (STEMI), and in patients younger than 75 years from 36% to 53%. However, for patients older than 75 years, diabetic, and patients with end-stage kidney disease, clopidogrel was the second most commonly used antiplatelet agent. Conclusion: In this real-life registry of patients with ACS, we observed there is still a high rate of use of clopidogrel, despite guidelines recommendations, and our analyses also showed a trend toward the use of ticagrelor. Patients who received new antiplatelet agents were patients with STEMI, younger than 75 years, and with less comorbidities. However, the use of ticagrelor and prasugrel remains low, highlighting a therapeutic inertia with considerable gap between evidence-based clinical guidelines and daily clinical practice.

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