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Risk of unfavorable long-term outcome in older adults with traumatic intracranial hemorrhage and anticoagulant or antiplatelet use.

AbstractSTUDY OBJECTIVE:
The objective was to compare neurological outcomes at 6 months in older patients with preinjury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage with those without prior use of these medications.
METHODS:
This was a retrospective study conducted at a Level 1 trauma center from April 2009 to July 2010. Patients older than 55 years with isolated mild head injury (Glasgow Coma Scale score 13-15 and Abbreviated Injury Score < 3 in nonhead body region) were included. Demographic, clinical, and outcome data were abstracted from an existing traumatic brain injury database. The primary end point of unfavorable extended Glasgow Outcome Score at 6 months was compared between patients with and without preinjury warfarin or clopidogrel use.
RESULTS:
Seventy-seven eligible patients were identified: 27 (35%) with preinjury warfarin or clopidogrel use and 50 (65%) without. Baseline characteristics (sex, Glasgow Coma Scale score, Injury Severity Score, computed tomography score, and in-hospital mortality) were similar between cohorts, although the preinjury warfarin or clopidogrel cohort was older than the control group (P < .05). Patients in the preinjury warfarin or clopidogrel cohort were more likely to have an unfavorable outcome (16/27; 59.3%; 95% confidence interval, 40.7%-77.8%) as compared with those without (18/50; 36.0%; 95% confidence interval, 22.7%-49.3%) (P = .05).
CONCLUSION:
Older adults with preinjury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage may be at an increased risk for unfavorable long-term neurological outcomes compared with similar patients without preinjury use of these medications.
AuthorsDaniel K Nishijima, Kiarash Shahlaie, Korak Sarkar, Nancy Rudisill, James F Holmes
JournalThe American journal of emergency medicine (Am J Emerg Med) Vol. 31 Issue 8 Pg. 1244-7 (Aug 2013) ISSN: 1532-8171 [Electronic] United States
PMID23759685 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
CopyrightCopyright © 2013 Elsevier Inc. All rights reserved.
Chemical References
  • Anticoagulants
  • Platelet Aggregation Inhibitors
  • Warfarin
  • Clopidogrel
  • Ticlopidine
Topics
  • Aged
  • Aged, 80 and over
  • Anticoagulants (adverse effects)
  • Clopidogrel
  • Female
  • Glasgow Coma Scale
  • Humans
  • Injury Severity Score
  • Intracranial Hemorrhage, Traumatic (complications, diagnosis)
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors (adverse effects)
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Ticlopidine (adverse effects, analogs & derivatives)
  • Trauma Centers (statistics & numerical data)
  • Warfarin (adverse effects)

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