M. Crawford1, S. Mansour1,2, A. Tymchak1,2, A. A. Fokin1, A. Zuviv1, J. Wycech1,3, I. Puente1,2,3,4 1Delray Medical Center,Trauma Services,Delray Beach, FL, USA 2Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 3Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 4Florida International University,College Of Medicine,Miami, FL, USA
Introduction:
Use of antiplatelet therapy (APT) has become widespread due to an aging population and increased incidence of cardiovascular disease. While effective at mitigating risks of cardiovascular disease, APT has been shown to increase the risk of hemorrhage in traumatic brain injury (TBI). We hypothesize that patients taking dual APT (Aspirin and Clopidogrel) will have more adverse events than TBI patients taking single APT, Aspirin (ASA) or Clopidogrel only.
Methods:
This IRB approved retrospective cohort study included 346 TBI patients on pre-injury ASA, Clopidogrel or both, ages 17 to 101, who were delivered to a level 1 trauma center between 1/1/2015 and 3/30/2018. Patients were divided into 2 groups by pre-injury APT: Group A was taking either ASA only or Clopidogrel only (n=259), and Group B was taking both ASA and Clopidogrel (n=87). Patients were excluded if they were also on anti-coagulants. Analyzed variables included age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), Rotterdam computed tomography (CT) score, Marshall CT score, incidence of intracranial hemorrhage (ICH), midline shift, platelet function and status, platelet transfusion, need for neurosurgical intervention, days of mechanical ventilation (DMV), Intensive Care Unit length of stay (ICULOS), hospital LOS (HLOS), re-admission rate and mortality.
Results:
Group B compared to Group A had higher mean ISS (12.1 vs 14.1; p=0.02), incidence of ICH (84.2% vs 93.1%; p=0.04), midline shift (5.8% vs 12.6%; p=0.04), Platelet Function Assay (PFA)-100 epinephrine (173.8 vs 224.0; p=0.001), TEG-Platelet Mapping (PM) % inhibition arachidonic acid (55.2 vs 69.2; p=0.04), TEG-PM % inhibition adenosine diphosphate (ADP) (36.4 vs 51.8; p=0.003), and need for neurosurgical intervention (2.7% vs 11.5%; p=0.001) (Fig. 1).
The two groups had comparable mean age (81.8 vs 80.3), GCS (14.3 vs 13.8), Rotterdam score (2.6 vs 2.6), Marshall score (1.1 vs 1.2), platelet count on admission (208.6 vs 222.7), PFA-100 ADP (131.9 vs 163.7), Thromboelastography Maximum Amplitude (TEG-MA) (67.1 vs 67.9), Partial Thromboplastin Time (26.3 vs 25.7 seconds), Prothrombin Time (1.1 vs 1.2 seconds), incidence of platelet transfusion (42.0% vs 39.0%), DMV (5.1 vs 6.1 days), ICULOS (2.9 vs 3.9 days), HLOS (3.7 vs 4.2 days), readmission rate (5.5% vs 4.6%) and mortality (9.7% vs 12.6%), with all p>0.09.
Conclusion:
Patients on dual APT had increased platelet dysfunction, increased incidence of intracranial hemorrhage and need for neurosurgical intervention compared to patients on single APT. This may suggest that increased precautions should be taken with this category of a patient.
