A. A. Fokin1, J. Wycech1,2, S. Mansour1,3, A. Tymchak1,3, A. Zuviv1,3, M. Crawford1, I. Puente1,2,3,4 1Delray Medical Center,Trauma Services,Delray Beach, FL, USA 2Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 3Florida Atlantic University,College Of Medicine,Boca Raton, 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 the risks of cardiovascular disease, APT may increase the risk of hemorrhage in traumatic brain injury (TBI). Our study seeks to determine outcomes in TBI patients on different pre-injury APT: aspirin (ASA), Plavix and dual APT of ASA and Plavix.
Methods: This IRB approved retrospective cohort study included 346 patients with TBI between the ages of 17 and 101, who were delivered to a level 1 trauma center between 1/1/2015 and 3/30/2018. Patients were divided into 3 groups, by type of pre-injury APT received: Group 1 patients had ASA only (n=203), Group 2 Plavix only (n=56), and Group 3 had dual APT (n=87). Patients were excluded if they were also taking anti-coagulants. Age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), Rotterdam computed tomography (CT) score, Marshall CT score, incidence of intracranial hemorrhage (ICH), venous thromboembolism (VTE) prophylaxis, need for neurosurgical intervention, duration of mechanical ventilation (DMV), Intensive Care unit length of stay (ICULOS), hospital LOS (HLOS), incidence of re-admission and mortality were compared.
Results: Between the groups, mean age (81.5 vs 82.2 vs 80.3 years; p=0.3), GCS (14.3 vs 14.6 vs 13.8; p=0.1), Rotterdam score (2.6 vs 2.6 vs 2.6; p=1.0), Marshall score (1.1 vs 1.0 vs 1.2; p=0.1), incidence of ICH (83.3% vs 87.5% vs 93.1%; p=0.1), DMV (4.9 vs 8.0 vs 6.14 days; p=0.7), ICULOS (3.0 vs 2.5 vs 3.9 days; p=0.2), HLOS (3.6 vs 4.0 vs 4.2 days; p=0.4), readmission rate (6.0% vs 3.6% vs 4.6%; p=0.7) and mortality (9.9% vs 8.9% vs 12.6%; p=0.7) were comparable. Mean ISS was different between groups (11.9 vs 12.5 vs 14.1; p=0.04), with a significantly higher ISS in Group 3 than Group 1 (p=0.04). The percent of patients receiving VTE prophylaxis was also significantly different between groups (8.9% vs 12.5% vs 6.9%; p<0.001), showing a significance of p<0.001 between Groups 1 and 3, and p=0.004 between Groups 2 and 3. Incidence of neurosurgical intervention was also different between groups (3.0% vs 1.8% vs 11.5%; p=0.004), showing significantly higher incidence in Group 3 than Group 1 (p=0.01) and Group 2 (p=0.03) (Fig. 1).
Conclusion: Patients on dual APT had an increase in neurosurgical interventions compared to patients taking either antiplatelet agent alone. While there was no difference in mortality among the three groups, there was a tendency toward increased incidence of ICH in patients on dual APT when compared to either group alone. VTE prophylaxis was administered less often to patients who were taking Plavix or dual APT when compared to patients taking ASA alone.
