Systematic Review and Meta-Analysis: Is Pre-Injury Antiplatelet Therapy Associated with Traumatic Intracranial Hemorrhage?

Abstract

The objective of this systematic review and meta-analysis is to evaluate whether the pre-injury use of antiplatelet therapy (APT) is associated with increased risk of traumatic intracranial hemorrhage (tICH) on CT scan. PubMed, Medline, Embase, Cochrane Central, reference lists, and national guidelines on traumatic brain injury were used as data sources. Eligible studies were cohort studies and case-control studies that assessed the relationship between APT and tICH. Studies without control group were not included. The primary outcome of interest was tICH on CT. Two reviewers independently selected studies, assessed methodological quality, and extracted outcome data. This search resulted in 10 eligible studies with 20,247 patients with head injury that were included in the meta-analysis. The use of APT in patients with head injury was associated with significant increased risk of tICH compared with control (odds ratio [OR] 1.87, 95% confidence interval [CI]1.27-2.74). There was significant heterogeneity in the studies (I 84%), although almost all showed an association between APT use and tICH. This association could not be established for patients receiving aspirin monotherapy. When considering only patients with mild traumatic brain injury (mTBI), the OR is 2.72 (95% CI 1.92-3.85). The results were robust to sensitivity analysis on study quality. In summary, APT in patients with head injury is associated with increased risk of tICH; this association is most relevant in patients with mTBI. Whether this association is the result of a causal relationship and whether this relationship also exists for patients receiving aspirin monotherapy cannot be established with the current review and meta-analysis.

Severe traumatic brain injury: targeted management in the intensive care unit

“…The main differences between younger and older patients with TBI are summarised in the panel. [34][35][36][37][38][39][40][41][42][43][44]…”

“…• Anticoagulant and antiplatelet drugs are used increasingly in the general population, 35 and particularly in elderly people; these drugs increase the risk of cerebral haemorrhagic lesions and might worsen the expansion of initial bleeding, even after modest TBIs. 36,37 • Polypharmacy-including sedatives or hypnotics, antidepressants, benzodiazepines, and antihypertensive drugs-is common in elderly patients but not in young adults; these drugs might increase instability and predispose patients to a fall. 38 • Elderly patients have less brain reserve than younger patients, 34 a vulnerability that amplifies the result of brain damage and hampers rehabilitation.…”

Management of moderate and severe traumatic brain injury

“…However, there is an association between antiplatelet use and development of acute traumatic intracranial hemorrhage. [85][86][87] Unfortunately, evidence to date suggests that platelet transfusion does not improve clinical outcome in TBI patients with intracranial hemorrhage [88][89][90] or nontraumatic intracerebral hemorrhage. 91 There is also an association between coumadin use and intracranial hemorrhage following TBI.…”

Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology

“…Wood and colleagues [ 24 ] found that patients with mTBI history who scored higher on measures of anxiety sensitivity and/or alexithymia tended to score higher on the Rivermead post-concussion symptom questionnaire at two weeks post injury than patients scoring lower on these measures. In a different study, cogniphobia, defined as “fearful avoidance of a specific headache trigger, mental exertion” [ 25 ] (p. 1), was found to be associated with worse memory test performance in a group of patients with mTBI history who reported more severe post-traumatic headaches [ 25 ]. The development of these dysfunctional feedback loops “may serve to maintain a variety of symptoms beyond the resolution of the original organic deficit” [ 26 ] (p. 552).…”