Central Surgical AssociationAntiplatelet agents, warfarin, and epidemic intracranial hemorrhage
Section snippets
Materials and methods
This study was approved by the Beth Israel Deaconess Medical Center Institutional Review Board before data collection and review. We reviewed our prospectively collected Trauma Registry database, examining the records of all patients admitted with intracranial hemorrhage in 2 time periods: 1999 to 2000 and 2007 to 2008. We also searched the hospital database for ICD-9-CM codes classifiable as TICH. All intracranial hemorrhages were considered traumatic if secondary to an identified external
Results
Of 5,371 trauma patients (T1, 2,230; T2, 3,141), 526 patients age ≥55 years with TICH were identified. In T1, 6.2% of traumas were TICH patients. This number doubled to 12.3% in T2 (P < .01; Fig 1). The mean age of the 2 groups was similar (77.6 years in T1 vs 77.5 years in T2). In T1, 48% of the patients were males; in T2, 49% of the patients were males (Table II).
The trauma mechanisms in T1 were 66% falls from standing, 12% falls down stairs, 4% falls from height, 6% pedestrians struck by a
Discussion
Anticoagulated patients are at increased risk of TICH after head injury. We see here that the incidence of TICH in our trauma population has doubled since the index period of 1999 to 2000. Our trauma center population, however, changed very little when comparing the rate of warfarin AC use for AF. The mortality and morbidity associated with this epidemic are substantial, and so it is important to understand it in better detail.
First, we sought to understand the reasons TICH patients had been
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Platelet dysfunction in patients with traumatic intracranial hemorrhage: Do desmopressin and platelet therapy help or harm?
2022, American Journal of SurgeryCitation Excerpt :Their increased risk of bleeding has rarely been associated with increased mortality except in the case of traumatic brain injury (TBI).2 Previous studies demonstrate a clear relationship between use of antiplatelet agents (APA) and the incidence of TBI.3,4 Select studies show an equivalent increase of intracranial hemorrhage (ICH) in patients taking warfarin, aspirin, and clopidogrel,5 while, other studies show that only patients taking aspirin and clopidogrel have higher incidence of ICH.6,7
Effects of anticoagulant and antiplatelet agents in severe traumatic brain injury in an asian population – A matched case-control study
2019, Journal of Clinical NeuroscienceCitation Excerpt :A local study reported an incidence of major bleeding events in patients receiving ACAP to be 4.56% within the first year of treatment [3]. There is also a trend towards increasing incidence of traumatic brain injuries presenting in emergency departments, as well as a significant increase in the prevalence of ACAP use in these patients [4–7]. It is generally thought that the use of ACAP would lead to increased risk of intracranial haemorrhage and poor outcomes in patients who present with TBI.
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2019, Journal of Surgical ResearchWorsening head bleeds in elderly blunt head trauma patients taking antithrombotics: Delayed CT head fails to change management
2019, InjuryCitation Excerpt :Our patient population is urban and of diminished socioeconomic status. Newer anticoagulant and antiplatelet medications were a rarity in this group during this study period, though globally most patients in America remain on aspirin and warfarin [7]. Our study did not have enough patients to draw conclusions about antithrombotics beyond aspirin, clopidogrel and warfarin.