Abstract
IntroductionPre-injury antithrombotic therapy might influence the outcome of subjects with head injuries and positive computed tomography (CT) scans. We aimed to determine the potential risk of pre-injury antiplatelet drug use on short- and long-term outcome of head injured subjects admitted to emergency departments (EDs) in Italy for extended observation.MethodsA total of 1,558 adult subjects with mild, moderate and severe head injury admitted to Italian EDs were studied. In multivariable logistic regression analyses, the short-term outcome was assessed by an evaluation of head CT scan at 6 to 24 hours after trauma and the long-term outcome by the Glasgow outcome scale (GOS) at six months.ResultsHead CT scan comparisons showed that 201 subjects (12.9%) worsened. The risk of worsening was increased two fold by the use of antiplatelet drugs (106, 19.7% treated versus 95, 9.3% untreated; relative risk (RR) 2.09, 95% CI 1.63 to 2.71). The risk was particularly high in subjects on clopidogrel (RR 5.76, 95% CI 3.88 to 8.54), independent of the association with aspirin. By logistic regression, 5 of 14 items were independently associated with worsening (Glasgow coma scale (GCS), Marshall category, antiplatelet therapy, intraventricular hemorrhage, number of lesions). After six months, only 4 of 14 items were predictors of unfavorable outcome (GOS 1 to 3) (GCS score, Marshall category, age in decades, intracerebral hemorrhage/contusion). The risk increased by 50% in the group treated with antiplatelet therapy (RR 1.58, 95% CI 1.28 to 1.95; P < 0.001).ConclusionsAntithrombotic therapy (in particular clopidogrel) is a risk factor for both short-term and long-term unfavorable outcome in subjects with head injury, increasing the risk of progression and death, permanent vegetative state and severe disability.
Highlights
Pre-injury antithrombotic therapy might influence the outcome of subjects with head injuries and positive computed tomography (CT) scans
We considered the few cases in which other non-steroidal anti-inflammatory drugs (NSAIDs) with a definite antiplatelet activity had been administered in the three days before trauma for other reasons
Data mining analysis did not select any relevant pattern in relation to different hospital facilities, that is, neurosurgery versus telemedicine systems versus none; P test for trend = 0.144). This observational study derived from Italian emergency departments (EDs) shows that pre-injury antithrombotic therapy is associated with negative outcomes in subjects with head injury and intracranial lesions with an indication of observation and conservative treatment; in the shortterm progression of lesions was seen on the CT scan, in the long-term the risk of unfavorable outcome increased
Summary
Pre-injury antithrombotic therapy might influence the outcome of subjects with head injuries and positive computed tomography (CT) scans. We aimed to determine the potential risk of pre-injury antiplatelet drug use on short- and long-term outcome of head injured subjects admitted to emergency departments (EDs) in Italy for extended observation. Subjects admitted to the emergency department (ED) with intracranial lesions following head injury are a special challenge for emergency physicians They represent a heterogeneous group of patients with large variability as to injury severity, clinical course, neurological recovery and overall outcome [1]. The aim of this study was to test the effect of pre-injury antiplatelet therapy on short- and long-term outcomes in subjects with head injury and a positive computed tomography (CT) scan at first evaluation The epidemiology of the trauma population has changed, with a larger and larger prevalence of older age-groups [7], where antiplatelet drug use is more prevalent, in the presence of comorbidities [8,9].
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