J. Pattison2, U. Pandya1 1Grant Medical Center,Trauma Services,Columbus, OH, USA 2Ohio University College Of Osteopathic Medicine,Heritage College Of Medicine,Athens, OH, USA
Introduction: Common indications for anticoagulant and/or antiplatelet medication use after injury include venous thromboembolism, blunt cerebrovascular injury, and atrial fibrillation to name a few. Patients with traumatic intracranial hemorrhage with a clinical indication for antiplatelet and/or anticoagulant medication present a significant clinical dilemma, burdened by the task of weighing the potential risks of hemorrhage expansion against the risk of withholding antithrombotic therapy. We speculate that specific types of intracranial hemorrhage may be more susceptible to hemorrhage expansion after post injury administration of antithrombotics. In this study, we sought to determine the effect of subdural hemorrhage on the risk of hemorrhage expansion after administration of antiplatelet and/or anticoagulant medication.
Methods: Medical records of 1,626 trauma patients admitted with traumatic intracranial hemorrhage between March 1, 2008 and March 31, 2013 to an adult level 1 trauma center were retrospectively reviewed. The pharmacy database was queried to determine which patients were administered anticoagulant (warfarin, therapeutic intravenous heparin, therapeutic weight based lovenox) or antiplatelet (clopidogrel, aspirin) medication during their hospitalization, leaving a sample of 97 patients that met inclusion criteria. Patients presenting with subdural hemorrhage were compared to patients without subdural hemorrhage. Demographic data, clinically significant expansion of hematoma (defined as the need to stop therapy due to worsening intracranial hemorrhage), post injury day of initiation, and mortality were analyzed. P values < 0.05 were considered statistically significant
Results: A total of 97 patients met inclusion criteria with 55 patients in the subdural hemorrhage group and 42 in the other intracranial hemorrhage group. There were no significant differences in age, gender, injury severity score, admission Glasgow coma score, or mean hospital day of antithrombotic administration between the 2 groups. Patients with subdural hemorrhage did have a significantly higher rate of intracranial hemorrhage expansion (9.1% vs 0%, p=0.045). There was no difference in overall hospital mortality between the 2 groups.
Conclusion: Incidence of intracranial hemorrhage expansion was higher in patients with subdural hemorrhage. It may be prudent to use special caution when administering antiplatelet or anticoagulant medication in this group of patients after injury. Further study could help better define which types of intracranial hemorrhage are most susceptible to expansion after antithrombotic administration.
