Mild Head Trauma: Is Antiplatelet Therapy a Risk Factor for Hemorrhagic Complications?

Abstract

Background and objectives: In patients who receive antiplatelet therapy (APT), the bleeding risk profile after mild head trauma (MHT) still needs clarification. Some studies have demonstrated an association with bleeding risk, whereas others have not. We studied the population of our level II emergency department (ED) trauma center to determine the risk of bleeding in patients receiving APT and whether bleeding results not from antiplatelet agents but rather from age. We assessed the bleeding risk, the incidence of intracranial hemorrhage (ICH) that necessitated hospitalization for observation, the need for cranial neurosurgery, the severity of the patient’s condition at discharge, and the frequency of ED revisits for head trauma in patients receiving APT. Materials and Methods: This retrospective single-center study included 483 patients receiving APT who were in the ED for MHT in 2019. The control group consisted of 1443 patients in the ED with MHT over the same period who were not receiving APT or anticoagulant therapy. Our ED diagnostic therapeutic protocol mandates both triage and the medical examination to identify patients with MHT who are taking any anticoagulant or APT. Results: APT was not significantly associated with bleeding risk (p > 0.05); as a risk factor, age was significantly associated with the risk of bleeding, even after adjustment for therapy. Patients receiving APT had a greater need of surgery (1.2% vs. 0.4%; p < 0.0001) and a higher rate of hospitalization (52.9% vs. 37.4%; p < 0.0001), and their clinical condition was more severe (evaluated according to the exit code value on a one-dimensional quantitative five-point numerical scale) at the time of discharge (p = 0.013). The frequency of ED revisits due to head trauma did not differ between the two groups. Conclusions: The risk of bleeding in patients receiving APT who had MHT was no higher than that in the control group. However, the clinical condition of patients receiving APT, including hospital admission for ICH monitoring and cranial neurosurgical interventions, was more severe.

Dysbarism: An Overview of an Unusual Medical Emergency

“…As reported in the pathophysiology of trauma, the barotrauma can affect several organs [60][61][62][63][64][65][66][67][68][69]. The most frequent injuries involve the sinuses and/or middle ear, but barotrauma may also cause facial, tooth, gastrointestinal (GI), pulmonary (pneumothorax, pulmonary hemorrhage), and mediastinal injuries.…”

The Impact of Preinjury Use of Antiplatelet Drugs on Outcomes of Traumatic Brain Injury: A Systematic Review and Meta-Analysis

“…Indeed, studies have found that the risk of bleeding is significantly higher with anticoagulants as compared to antiplatelets alone (11). In the case of patients sustaining TBI, research suggests that preinjury use of anticoagulants (12) is a significant risk factor for developing ICH after TBI whereas corresponding evidence for antiplatelet drugs is ambiguous (13,14). Recent meta-analysis studies have assessed the impact of preinjury anticoagulation on outcomes of general trauma and TBI patients and have noted significantly increased mortality in anticoagulant users as compared to controls (1,10).…”

Mild Head Trauma (MHT) and Antiplatelet Therapy. Reply to Lorenzati et al. Comment on “Savioli et al. Mild Head Trauma: Is Antiplatelet Therapy a Risk Factor for Hemorrhagic Complications? Medicina 2021, 57, 357”

“…Anticoagulant therapies are suitable for multiple indications, and they were applied in several cohort studies [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The use of these drugs aggravates the risk of traumatic intracranial injury and influences the clinical outcomes after MHI and blunt head trauma [ 16 , 17 , 18 , 19 , 20 , 21 ]. However, there are no clear guidelines about the management of patients treated with vitamin K antagonist (VKA), new oral direct anticoagulants (DOACs), and antiplatelet agents (APT), unless they underwent a head CT scan upon admission to the ED, and after 24–48 h. As the use of DOACs is becoming more frequent, there has been a more tangible interest in this topic, as well as prospective studies and literature reviews [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ].…”

“…We conducted a study to assess the bleeding risk profiles of patients admitted to the ED for MHI under DOACs and traditional VKAs [ 16 ]. The primary endpoint was to dictate the difference between the recurrency and complications of post-traumatic ICH following MHI.…”