M. Choi1, N. K. Dhillon1, E. J. Smith1, R. C. Kolus1, D. Polevoi1, N. Linaval1, G. Barmparas1, E. J. Ley1 1Cedars-Sinai Medical Center,Los Angeles, CA, USA
Introduction: With the increasing use of anticoagulant and antiplatelet (ACAP) medication, it is common for trauma patients to present with brain injury while taking one or more of these medications. While patients with traumatic brain injury who are taking ACAP are known to be at greater risk for progression of intracranial hemorrhage (ICH) how dual antiplatelet therapy affects ICH is unknown.
Methods: A retrospective review was conducted at a Level 1 trauma center from January 2011 to December 2015 for patients who were admitted with a diagnosis of ICH. Patients on a single antiplatelet agent, dual antiplatelet therapy, and warfarin were identified and compared to patients not on an ACAP. Data was collected on patient demographics, mechanism of injury, injury severity scores, admission GCS, ICU length of stay (LOS), hospital LOS, prior to admission medications, results of imaging studies, information regarding procedures, and mortality.
Results: Of the 317 patients analyzed, 246 (77.6%) were not on any ACAP, while those who were included: aspirin alone 38 (12%), clopidogrel alone 6 (1.9%), combined aspirin and clopidogrel 15 (4.7%), and warfarin 12 (3.8%). The mean age was 56 (34.3-78) years and 69.4% were male, median head AIS was 4 (3-4) and median ISS was 18 (14.5-26). ICU and hospital LOS were 3 (2-5) and 6 (4-14.75) days, respectively. Patients taking ACAP did not have a higher rate of ICH progression on imaging compared to those who were not (Table). Those on warfarin required more interventions compared to patients not on an ACAP (41.6% vs. 14.6%, p=0.03) or on aspirin alone (41.6% vs. 7.9%, p=0.01). When imaging and interventions were combined, patients on dual antiplatelet had significant disease progression compared to no ACAP (60% vs 33.3%, p=0.04) and aspirin alone (60% vs. 23.7%, p=0.01). Mortality was similar among all cohorts.
Conclusion: Dual antiplatelet therapy was associated with a greater rate of clinical progression of ICH. Patients who present with dual antiplatelet therapy should be identified as high risk for deterioration.
