Effects of Antiplatelet Agents on Outcomes for Elderly Patients With Traumatic Intracranial Hemorrhage

Ohm, Christina; Mina, Alfred; Howells, Greg A.; Bair, Holly A.; Bendick, Phillip J.

doi:10.1097/01.ta.0000151671.35280.8b

Cited by 179 publications

(91 citation statements)

References 6 publications

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“…It has been suggested that an increase of 1% -2% of ICH rates can negate the benefits of antithrombotic therapy [11]. It should be noted that while the mortality of our study is disproportionately higher to what has been described in the literature [29] [30], this is the first paper, to our knowledge, that assesses the adverse effects of APAC use on patients presenting with surgically-treated intracranial hemorrhage.…”

Section: Discussioncontrasting

confidence: 38%

Premorbid Use of Clopidogrel Portends Worse Outcomes in Patients Treated Surgically for Intracranial Hemorrhage

Marvin¹,

Danison²,

Davis³

et al. 2014

OJMN

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Background: Widespread use of antiplatelet and anticoagulation medications (APACs) can be a difficult challenge in the presence of a neurosurgical emergency. Premorbid use of APACs, particularly clopidogrel, has been shown to affect outcomes in patients with stroke and traumatic brain injury. Objective: We hypothesized that pre-morbid clopidogrel use in patients with intracranial hemorrhage necessitating surgical intervention would lead to a greater risk of death and need for re-operation than those taking other APACs. Methods: Retrospective single institution review was conducted from January, 2010 through November, 2012 for intracranial hemorrhages necessitating surgical evacuation. Acute, subacute and chronic subdural, epidural and intraparenchymal hemorrhages were included. Results: 185 of 410 patients that required surgery for intracranial hemorrhage were on APACs. Overall mortality rate was 33%, with a 37% mortality rate in the APAC group. Overall reoperation rate was 7.5%, and 13%

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Section: Discussioncontrasting

confidence: 38%

Premorbid Use of Clopidogrel Portends Worse Outcomes in Patients Treated Surgically for Intracranial Hemorrhage

Marvin¹,

Danison²,

Davis³

et al. 2014

OJMN

View full text Add to dashboard Cite

show abstract

“…However, they did not match comorbid conditions between cases and controls, with 71.1% of cases manifesting three or more conditions, compared with 34.8% in the control. 11 The greater number of comorbid conditions may have had an impact on the increased mortality seen in the cases. In contrast, a study by Spektor et.…”

Section: Aspirinmentioning

confidence: 99%

“…9 More recent papers have documented the increased risk of death with aspirin therapy in patients with radiographic evidence of intracranial injury. 10,11 Mina et. al found a statistically significant mortality rate (47%) in those taking aspirin compared with controls (8%).…”

Section: Aspirinmentioning

confidence: 99%

Outcomes in Traumatic Brain Injury Patients on Preinjury Anticoagulation and Antiplatelet Agents

Ba¹,

Thakkar²,

Jallo³

2013

JHN Journal

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“…Due to the prevalent use of antiplatelet medications, many trauma patients present with chemical coagulopathy from medications such as aspirin or clopidogrel. This chemical coagulopathy potentiates the already morbid ATC; as a result, the initial resuscitation and management of these patients requires additional assessment and interventions [5][6][7][8] . Previously, we reported our experience with the Platelet Function Assay-100™ (PFA-100, Dade Behring, Deerfield, IL) identifying clopidogrel use in traumatic brain injury (TBI) and stroke patients with a sensitivity and specificity of 48.6% and 74.8%, respectively 9 .…”

Section: Introducti̇onmentioning

confidence: 99%

Thromboelastography with Platelet Mapping as an Alternative for the Platelet Function Assay-100 in Detecting Clopidogrel in Trauma Patients

Ahmad¹,

Bartels²,

Bs³

et al. 2017

SDRP-JAS

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ObjectivesAntiplatelet therapy is prevalent and can potentiate bleeding complications associated with trauma and surgery. Laboratory identification and quantification of the effect of antiplatelet medications has been difficult, with several assays, including the Platelet Function Assay [PFA]-100, yielding inconclusive results. The purpose of this study was to evaluate the effectiveness of thromboelastography with platelet mapping (TEG-PM) to identify the presence of antiplatelet medications and compare these results with the PFA-100. MethodsAll trauma patients with TEG-PM studies from September 2013 to September 2014 were retrospectively collected. The medical records were reviewed to determine home antiplatelet medications. Patients were then evaluated for concurrent PFA-100 tests to allow direct comparison of the studies. ResultsTwenty-one patients had both TEG-PM and PFA-100 test performed. In this set of patients, the sensitivity and specificity of the PFA for detecting antiplatelet medications was 50.0% and 61.9%, respectively; the TEG-PM had 88.9% sensitivity and 41.7% specificity for detecting aspirin and 100% sensitivity and 8.3% specificity for detecting clopidogrel. ConclusionThromboelastography with platelet mapping was more sensitive for detecting both aspirin and clopidogrel than the PFA-100; the 100% sensitivity in detecting clopidogrel is key and indicates this may be a useful screening tool to rule out clopidogrel use in trauma patients. Interestingly, there is a very low specificity, which may be related to acute traumatic coagulopathy.

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Effects of Antiplatelet Agents on Outcomes for Elderly Patients With Traumatic Intracranial Hemorrhage

Abstract: The use of antiplatelet agents with elderly trauma patients significantly increases the risk of mortality when head injury involves intracranial hemorrhage.

Cited by 179 publications

References 6 publications

Premorbid Use of Clopidogrel Portends Worse Outcomes in Patients Treated Surgically for Intracranial Hemorrhage

Premorbid Use of Clopidogrel Portends Worse Outcomes in Patients Treated Surgically for Intracranial Hemorrhage

Outcomes in Traumatic Brain Injury Patients on Preinjury Anticoagulation and Antiplatelet Agents

Thromboelastography with Platelet Mapping as an Alternative for the Platelet Function Assay-100 in Detecting Clopidogrel in Trauma Patients

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