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

Alter, Scott M.; Mazer, Benjamin A; Solano, Joshua J.; Shih, Richard D.; Hughes, Mary J.; Clayton, Lisa M; Greaves, Spencer W.; Trinh, Nhat Q; Hughes, Patrick G.

doi:10.1136/tsaco-2020-000520

Cited by 11 publications

(10 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study’s relatively low incidence of TICH in ACT-patients has been reported by several other studies in the past years [ 1 , 15 – 20 ]. Even though one-third of the ACT-patients in the present study were on VKAs and not DOACs, the TICH-incidence did not differ significantly from the TICH-incidence in the cohort of patients with ground-level traumas not on ACT or APT.…”

Section: Discussionsupporting

confidence: 78%

“…Even though one-third of the ACT-patients in the present study were on VKAs and not DOACs, the TICH-incidence did not differ significantly from the TICH-incidence in the cohort of patients with ground-level traumas not on ACT or APT. Given the state of current research where VKA has shown higher TICH-incidence compared to DOAC, it is possible that the TICH-incidence would be even lower in this subgroup in a population where VKAs were less frequent [ 1 , 15 , 16 ]. If the RR of 1.78 for APT-patients can be properly demonstrated in a study with sufficient sample size, there is a substantial TICH-hazard for APT-patients.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of TICH in patients with APT has been reported between 10 and 40% compared to 5 and 20% in ACT-patients. TICH seems to be lower in patients on direct-acting oral anticoagulants (DOACs) than in patients taking Vitamin-K Antagonists (VKAs) [1,[15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study

Vedin

Forberg

Anefjäll

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Background Traumatic brain injury (TBI) is a common injury and constitutes up to 3% of emergency department (ED) visits. Current studies show that TBI is most commonly inflicted in older patients after ground-level falls. These patients often take medications affecting coagulation such as anticoagulants or antiplatelet drugs. Guidelines for ED TBI-management assume that anticoagulation therapy (ACT) confers a higher risk of traumatic intracranial hemorrhage (TICH) than antiplatelet therapy (APT). However, recent studies have challenged this. This study aimed to evaluate if oral anticoagulation and platelet inhibitors affected rate of TICH in head-trauma patients with ground-level falls. Methods This was a retrospective review of medical records during January 1, 2017 to December 31, 2017 and January 1 2020 to December 31, 2020 of all patients seeking ED care because of head-trauma. Patients ≥ 18 years with ground-level falls were included. Results The study included 1938 head-trauma patients with ground-level falls. Median age of patients with TICH was 81 years. The RR for TICH in APT-patients compared to patients without medication affecting coagulation was 1.72 (p = 0.01) (95% Confidence Interval (CI) 1.13–2.60) and 1.08 (p = 0.73), (95% CI 0.70–1.67) in ACT-patients. APT was independently associated with TICH in regression analysis (OR 1.59 (95% CI 1.02–2.49), p = 0.041). Conclusion This study adds to the growing evidence that APT-patients with ground-level falls might have as high or higher risk of TICH than ACT-patients. This is not addressed in the current guidelines which may need to be updated. We therefore recommend broad prospective studies.

show abstract

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study

Vedin

Forberg

Anefjäll

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…Recommendation 13: the risk of bleeding needs to be assessed before initiating antiplatelet therapy in patients with trauma-induced hypercoagulopathy complicated by arterial thrombosis Antiplatelet drugs inhibit cyclooxygenase (COX)-1, P2Y12 receptor, phosphodiesterase (PDE), or GPIIb/IIIa. This class of drugs is the first-line treatment for arterial thrombosis, but it can also increase bleeding risk in trauma patients [100]. Therefore, any antiplatelet therapy should only be planned after careful assessment of the bleeding risk in patients with trauma-induced hypercoagulopathy complicated by arterial thrombosis.…”

Section: Recommendation 11: Reducing Stress and Tissue Damage Are Prerequisites For Improving Trauma-induced Hypercoagulopathymentioning

confidence: 99%

Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy

Song¹,

Yang²,

Zhao

et al. 2021

Military Med Res

View full text Add to dashboard Cite

Trauma-induced coagulopathy (TIC) is caused by post-traumatic tissue injury and manifests as hypercoagulability that leads to thromboembolism or hypocoagulability that leads to uncontrollable massive hemorrhage. Previous studies on TIC have mainly focused on hemorrhagic coagulopathy caused by the hypocoagulable phenotype of TIC, while recent studies have found that trauma-induced hypercoagulopathy can occur in as many as 22.2–85.1% of trauma patients, in whom it can increase the risk of thrombotic events and mortality by 2- to 4-fold. Therefore, the Chinese People’s Liberation Army Professional Committee of Critical Care Medicine and the Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association jointly formulated this Chinese Expert Consensus comprising 15 recommendations for the definition, pathophysiological mechanism, assessment, prevention, and treatment of trauma-induced hypercoagulopathy.

show abstract

“…Among older patients, this platelet‐associated TBI coagulopathy is usually attributed to antiplatelet therapy and co‐morbidities, 11,12 and the use of any form of anticoagulant may exclude patients from studies of TBI coagulopathy 8,13 . In addition, normal platelet counts have been shown to decrease after age 50 years, 14 potentially increasing mortality risk for older adults presenting with TBI.…”

Section: Introductionmentioning

confidence: 99%

Age, admission platelet count, and mortality in severe isolated traumatic brain injury: A retrospective cohort study

et al. 2023

View full text Add to dashboard Cite

BackgroundWe asked whether patients >50 years of age with acute traumatic brain injury (TBI) present with lower platelet counts and whether lower platelet counts are independently associated with mortality.MethodsWe combined trauma registry and laboratory data on a retrospective cohort of all patients ≥18 years of age admitted to our Level 1 US regional trauma center 2015–2021 with severe (Head Abbreviated Injury Score [AIS] ≥3), isolated (all other AIS <3) TBI who had a first platelet count within 1 h of arrival. Age and platelet count were assessed continuously and as groups (age 18–50 vs. >50, platelet normals, and at conventional transfusion thresholds). Outcomes such as mean admission platelet counts and in‐hospital mortality were assessed categorically and with logistic regression.ResultsOf 44,056 patients, 1298 (3%, median age: 52 [IQR 33,68], 76.1% male) met all inclusion criteria with no differences between younger and older age groups for (ISS; 18 [14,26] vs. 17 [14,26], p = .22), New ISS (NISS; 29 [19,50] vs. 28 [17,50], p = .36), or AIS‐Head (4 [3,5] vs. 4 [3,5]; p = .87). Patients aged >50 had lower admission platelet counts (219,000 ± 93,000 vs. 242,000 ± 76,000/μL; p < .001) and greater in‐hospital mortality (24.5% vs. 15.6%, p < .001) than those 18–50. In multivariable regression, firearms injuries (OR9.08), increasing age (OR1.004), NISS (OR1.007), and AIS‐Head (OR1.05), and decreasing admission platelet counts (OR0.998) were independently associated with mortality (p < .001–.041). Platelet transfusion in the first 4 h of care was more frequent among older patients (p < .001).ConclusionsOlder patients with TBI had lower admission platelet counts, which were independently associated with greater mortality.

show abstract

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

Cited by 11 publications

References 25 publications

Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study

Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study

Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy

Age, admission platelet count, and mortality in severe isolated traumatic brain injury: A retrospective cohort study

Contact Info

Product

Resources

About