Details:

Alternative Title:
Ann Emerg Med
Personal Author:
Probst, Marc A. ; Gupta, Malkeet ; Hendey, Gregory W. ; Rodriguez, Robert M. ; Winkle, Gary ; ... More +
Probst, Marc A. ; Gupta, Malkeet ; Hendey, Gregory W. ; Rodriguez, Robert M. ; Winkle, Gary ; Loo, George T. ; Mower, William R. Less -
Description:
Objective:

To determine the prevalence of significant intracranial injury among adults with blunt head trauma who are on preinjury anticoagulant or antiplatelet medications.

Methods:

This was a multicenter, prospective, observational, study conducted from December 2007 to December 2015. Patients were enrolled in three emergency departments in the United States. Adults with blunt head trauma who underwent neuroimaging in the emergency department were included. Use of preinjury aspirin, clopidogrel, warfarin was recorded. Data on direct oral anticoagulants was not specifically recorded. The primary outcome was prevalence of significant intracranial injury on neuroimaging. The secondary outcome was receipt of neurosurgical intervention.

Results:

Among 9,070 patients enrolled in this study, the median age was 53.8 years (IQR: 34.7 to 74.3) and 60.7% were male. A total of 1,323 patients (14.6%) were taking antiplatelet medications or warfarin, including 635 taking aspirin alone, 109 clopidogrel alone, and 406 warfarin alone. As compared to patients without any coagulopathy, the relative risk of significant intracranial injury was 1.29 (95% CI: 0.88, 1.87) for patients taking aspirin alone, 0.75 (95% CI: 0.24, 2.30) for those taking clopidogrel alone, and 1.88 (95% CI: 1.28, 2.75) taking warfarin alone. The relative risk of significant intracranial injury was 2.88 (95% CI: 1.53, 5.42) for patients taking aspirin and clopidogrel in combination.

Conclusions:

Patients on preinjury warfarin or a combination of aspirin and clopidogrel were at increased risk for significant intracranial injury, but not those on aspirin alone. Clinicians should have a low threshold for neuroimaging when evaluating patients on warfarin or on a combination of aspirin and clopidogrel.


Subject:
[+]
Adult
Aged
Aged, 80 And Over
Anticoagulants
Article
Aspirin
Brain Injuries
Clopidogrel
Female
Head Injuries, Closed
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors
Prevalence
Prospective Studies
Risk Factors
Warfarin

Source:
Ann Emerg Med. 75(3):354-364
Pubmed ID:
31959538
Pubmed Central ID:
PMC7039766
Document Type:
Journal Article
Funding:
F32 HL120466/HL/NHLBI NIH HHS/United States ; K23 HL132052/HL/NHLBI NIH HHS/United States ; R01 CE001589/CE/NCIPC CDC HHS/United States ; R01 HS009699/HS/AHRQ HHS/United States
F32 HL120466/HL/NHLBI NIH HHS/United States ; K23 HL132052/HL/NHLBI NIH HHS/United States ; R01 CE001589/CE/NCIPC CDC HHS/United States ; R01 HS009699/HS/AHRQ HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:5473d405d40b74ba6ae690145030ff921900ed87e35d42ae124542ccc9fa3831
File Type:

Supporting Files

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  	NIHMS1543999-supplement-1.docx	docx

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