Mild Head Trauma: Is Antiplatelet Therapy a Risk Factor for Hemorrhagic Complications?

Overview

Journal Medicina (Kaunas)

Publisher MDPI

Specialty General Medicine

Date 2021 Apr 30

PMID 33917141

Citations 15

Authors

Gabriele Savioli

Iride Francesca Ceresa

Sabino Luzzi

Alice Giotta Lucifero

Maria Serena Pioli Di Marco

Federica Manzoni

Lorenzo Preda

Giovanni Ricevuti

Maria Antonietta Bressan

Affiliations

Soon will be listed here.

Abstract

In patients who receive antiplatelet therapy (APT), the bleeding risk profile after mild head trauma (MHT) still needs clarification. Some studies have demonstrated an association with bleeding risk, whereas others have not. We studied the population of our level II emergency department (ED) trauma center to determine the risk of bleeding in patients receiving APT and whether bleeding results not from antiplatelet agents but rather from age. We assessed the bleeding risk, the incidence of intracranial hemorrhage (ICH) that necessitated hospitalization for observation, the need for cranial neurosurgery, the severity of the patient's condition at discharge, and the frequency of ED revisits for head trauma in patients receiving APT. This retrospective single-center study included 483 patients receiving APT who were in the ED for MHT in 2019. The control group consisted of 1443 patients in the ED with MHT over the same period who were not receiving APT or anticoagulant therapy. Our ED diagnostic therapeutic protocol mandates both triage and the medical examination to identify patients with MHT who are taking any anticoagulant or APT. APT was not significantly associated with bleeding risk ( > 0.05); as a risk factor, age was significantly associated with the risk of bleeding, even after adjustment for therapy. Patients receiving APT had a greater need of surgery (1.2% vs. 0.4%; < 0.0001) and a higher rate of hospitalization (52.9% vs. 37.4%; < 0.0001), and their clinical condition was more severe (evaluated according to the exit code value on a one-dimensional quantitative five-point numerical scale) at the time of discharge ( = 0.013). The frequency of ED revisits due to head trauma did not differ between the two groups. The risk of bleeding in patients receiving APT who had MHT was no higher than that in the control group. However, the clinical condition of patients receiving APT, including hospital admission for ICH monitoring and cranial neurosurgical interventions, was more severe.

Citing Articles

Comparative Analysis of Antithrombotic Therapy Outcomes in Mild Traumatic Brain-Injury Patients: A Focus on Bleeding Risk and Hospital-Stay Duration.

Desai A, Shiffer D, Giordano M, Lucifero A, Generali E, Reggiani F Life (Basel). 2024; 14(3).

PMID: 38541634 PMC: 10970953. DOI: 10.3390/life14030308.

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study.

Savioli G, Ceresa I, Bressan M, Piccini G, Novelli V, Cutti S J Pers Med. 2024; 14(2).

PMID: 38392628 PMC: 10890089. DOI: 10.3390/jpm14020195.

Acute Oncologic Complications: Clinical-Therapeutic Management in Critical Care and Emergency Departments.

Gri N, Longhitano Y, Zanza C, Monticone V, Fuschi D, Piccioni A Curr Oncol. 2023; 30(8):7315-7334.

PMID: 37623012 PMC: 10453099. DOI: 10.3390/curroncol30080531.

Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding-The CREONTE (Crowding and RE-Organization National TriagE) Study Group.

Savioli G, Ceresa I, Bressan M, Piccini G, Varesi A, Novelli V Medicina (Kaunas). 2023; 59(4).

PMID: 37109739 PMC: 10143416. DOI: 10.3390/medicina59040781.

Retrospective cohort study to determine the effect of preinjury antiplatelet or anticoagulant therapy on mortality in patients with major trauma.

Yamaji F, Okada H, Kamidani R, Kawasaki Y, Yoshimura G, Mizuno Y Front Med (Lausanne). 2023; 9:1089219.

PMID: 36698798 PMC: 9868405. DOI: 10.3389/fmed.2022.1089219.

References

Gerdtz M, Collins M, Chu M, Grant A, Tchernomoroff R, Pollard C . Optimizing triage consistency in Australian emergency departments: the Emergency Triage Education Kit. Emerg Med Australas. 2008; 20(3):250-9. DOI: 10.1111/j.1742-6723.2008.01089.x. View

Hodge A, Hugman A, Varndell W, Howes K . A review of the quality assurance processes for the Australasian Triage Scale (ATS) and implications for future practice. Australas Emerg Nurs J. 2013; 16(1):21-9. DOI: 10.1016/j.aenj.2012.12.003. View

Savioli G, Ceresa I, Guarnone R, Muzzi A, Novelli V, Ricevuti G . Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to "Access Block". West J Emerg Med. 2022; 22(4):860-870. PMC: 8328174. DOI: 10.5811/westjem.2021.2.49611. View

Filipovsky J . Arterial hypertension in the elderly. Vnitr Lek. 2019; 64(11):987-992. View

Major J, Reed M . A retrospective review of patients with head injury with coexistent anticoagulant and antiplatelet use admitted from a UK emergency department. Emerg Med J. 2009; 26(12):871-6. DOI: 10.1136/emj.2008.068643. View

van den Brand C, Tolido T, Rambach A, Hunink M, Patka P, Jellema K . Systematic Review and Meta-Analysis: Is Pre-Injury Antiplatelet Therapy Associated with Traumatic Intracranial Hemorrhage?. J Neurotrauma. 2016; 34(1):1-7. DOI: 10.1089/neu.2015.4393. View

Sultan H, Boyle A, Pereira M, Antoun N, Maimaris C . Application of the Canadian CT head rules in managing minor head injuries in a UK emergency department: implications for the implementation of the NICE guidelines. Emerg Med J. 2004; 21(4):420-5. PMC: 1726397. DOI: 10.1136/emj.2003.011353. View

Savioli G, Ceresa I, Luzzi S, Gragnaniello C, Lucifero A, Del Maestro M . Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists. Medicina (Kaunas). 2020; 56(6). PMC: 7353902. DOI: 10.3390/medicina56060308. View

Bhatt D, Steg P, Ohman E, Hirsch A, Ikeda Y, Mas J . International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA. 2006; 295(2):180-9. DOI: 10.1001/jama.295.2.180. View

10.

McMillian W, Rogers F . Management of prehospital antiplatelet and anticoagulant therapy in traumatic head injury: a review. J Trauma. 2009; 66(3):942-50. DOI: 10.1097/TA.0b013e3181978e7b. View

11.

Patrono C, Bachmann F, Baigent C, Bode C, De Caterina R, Charbonnier B . Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European society of cardiology. Eur Heart J. 2004; 25(2):166-81. DOI: 10.1016/j.ehj.2003.10.013. View

12.

Nishijima D, Gaona S, Waechter T, Maloney R, Bair T, Blitz A . Do EMS Providers Accurately Ascertain Anticoagulant and Antiplatelet Use in Older Adults with Head Trauma?. Prehosp Emerg Care. 2016; 21(2):209-215. PMC: 5336488. DOI: 10.1080/10903127.2016.1218985. View

13.

Joseph B, Pandit V, Aziz H, Kulvatunyou N, Hashmi A, Tang A . Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: a prospective analysis. J Trauma Acute Care Surg. 2014; 76(3):817-20. DOI: 10.1097/TA.0b013e3182aafcf0. View

14.

Jones K, Sharp C, Mangram A, Dunn E . The effects of preinjury clopidogrel use on older trauma patients with head injuries. Am J Surg. 2006; 192(6):743-5. DOI: 10.1016/j.amjsurg.2006.08.037. View

15.

Fernandez-Abinader J, Gonzalez-Colon K, Feliciano C, Mosquera-Soler A . Traumatic Brain Injury Profile of an Elderly Population in Puerto Rico. P R Health Sci J. 2017; 36(4):237-239. View

16.

Hamamoto J, Yamase H, Yamase Y . Impacts of the introduction of a triage system in Japan: a time series study. Int Emerg Nurs. 2013; 22(3):153-8. DOI: 10.1016/j.ienj.2013.10.006. View

17.

Nishijima D, Offerman S, Ballard D, Vinson D, Chettipally U, Rauchwerger A . Risk of traumatic intracranial hemorrhage in patients with head injury and preinjury warfarin or clopidogrel use. Acad Emerg Med. 2013; 20(2):140-5. PMC: 3576045. DOI: 10.1111/acem.12074. View

18.

FitzGerald G, Jelinek G, Scott D, Gerdtz M . Emergency department triage revisited. Emerg Med J. 2010; 27(2):86-92. DOI: 10.1136/emj.2009.077081. View

19.

Khalayleh H, Lin G, Kadar Sfarad H, Mostafa M, Abu Abed N, Imam A . Traumatic Minor Intracranial Hemorrhage: Management by Non-neurosurgeon Consultants in a Regional Trauma Center is Safe and Effective. World J Surg. 2018; 43(2):497-503. DOI: 10.1007/s00268-018-4821-5. View

20.

Brewer E, Reznikov B, F Liberman R, Baker R, Rosenblatt M, David C . Incidence and predictors of intracranial hemorrhage after minor head trauma in patients taking anticoagulant and antiplatelet medication. J Trauma. 2010; 70(1):E1-5. DOI: 10.1097/TA.0b013e3181e5e286. View