Journal article
Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: A prospective analysis
The journal of trauma and acute care surgery, Vol.76(3), pp.817-820
03/01/2014
DOI: 10.1097/TA.0b013e3182aafcf0
PMID: 24553554
Abstract
BACKGROUND Patients receiving antiplatelet medications are considered to be at an increased risk for traumatic intracranial hemorrhage after blunt head trauma. However, most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate clinical outcomes and the requirement of a repeat head computed tomography (RHCT) in patients on preinjury clopidogrel therapy.
METHODS Patients with traumatic brain injury with intracranial hemorrhage on initial head CT were prospectively enrolled. Patients on preinjury clopidogrel were matched with patients exclusive of antiplatelet and anticoagulation therapy using a propensity score in a 1:1 ratio for age, Glasgow Coma Scale (GCS), head Abbreviated Injury Scale (h-AIS), Injury Severity Score (ISS), neurologic examination, and platelet transfusion. Outcome measures were progression on RHCT scan and need for neurosurgical intervention.
RESULTS A total of 142 patients with intracranial hemorrhage on initial head CT scan (clopidogrel, 71; no clopidogrel, 71) were enrolled. The mean (SD) age was 70.5 (15.1) years, 66% were male, median GCS score was 14 (range, 3-15), and median h-AIS (ISS) was 3 (range, 2-5). The mean (SD) platelet count was 210 (101), and 61% (n = 86) of the patients received platelet transfusion. Patients on preinjury clopidogrel were more likely to have progression on RHCT (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.1-7.1) and RHCT as a result of clinical deterioration (OR, 2.1; 95% CI, 1.8-3.5). The overall rate of neurosurgical intervention was 4.2% (n = 6). Patients on clopidogrel therapy were more likely to require a neurosurgical intervention (OR, 1.8; 95% CI, 1.4-3.1).
CONCLUSION Preinjury clopidogrel therapy is associated with progression of initial insult on RHCT scan and need for neurosurgical intervention. Preinjury clopidogrel therapy as an independent variable should warrant the need for a routine RHCT scan in patients with traumatic brain injury.
LEVEL OF EVIDENCE Prognostic study, level I; therapeutic study, level II.
Details
- Title: Subtitle
- Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: A prospective analysis
- Creators
- Bellal Joseph - University of ArizonaViraj Pandit - University of ArizonaHassan Aziz - University of ArizonaNarong Kulvatunyou - University of ArizonaAmmar Hashmi - University of ArizonaAndrew Tang - University of ArizonaTerence O'Keeffe - University of ArizonaJulie Wynne - University of ArizonaGary Vercruysse - University of ArizonaRandall S. Friese - University of ArizonaPeter Rhee - University of Arizona
- Resource Type
- Journal article
- Publication Details
- The journal of trauma and acute care surgery, Vol.76(3), pp.817-820
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/TA.0b013e3182aafcf0
- PMID
- 24553554
- ISSN
- 2163-0755
- eISSN
- 2163-0763
- Number of pages
- 4
- Language
- English
- Date published
- 03/01/2014
- Academic Unit
- Surgery
- Record Identifier
- 9984701658002771
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