Low-dose aspirin prophylaxis and risk of intracranial hemorrhage in patients older than 60 years of age with mild or moderate head injury: a prospective study

Spektor, Sergey; Agus, Samuel; Merkin, Vladimir; Constantini, Shlomo

doi:10.3171/jns.2003.99.4.0661

Cited by 78 publications

(44 citation statements)

References 15 publications

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“…Coagulopathy has been considered a risk factor for intracranial injury, 9,33) but low-dose aspirin does not increase the risk of intracranial hemorrhage in patients older than 60 years of age. 26) The presence of fracture was only assessed in 59% of our patients, but had a strong influence on intracranial lesions, as previously reported. 5,11,25,31) However, which patients should undergo skull radiography, and timing are unclear.…”

Section: Ct Indications In Mild Head Injurymentioning

confidence: 64%

Indications for Computed Tomography in Patients With Mild Head Injury

Ono

Wada

Takahara

et al. 2007

Neurol. Med. Chir.(Tokyo)

137

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The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46 ± 23 years), with mild head injury (Glasgow Coma Scale [GCS] score AE14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r ＝ 0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age AE60 years, male sex, JCS score AE1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score À0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age AE60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n ＝ 21) or patient request (n ＝ 17). These indications for CT including JCS may be useful in the management of patients with mild head injury.

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Section: Ct Indications In Mild Head Injurymentioning

confidence: 64%

Indications for Computed Tomography in Patients With Mild Head Injury

Ono

Wada

Takahara

et al. 2007

Neurol. Med. Chir.(Tokyo)

137

View full text Add to dashboard Cite

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“…Comparative works have studied the relationship between high INR anticoagulation vs. antiplatelet therapy in patients with ischemic disease, showing more intracranial bleeding rate in the first group [49][50][51], but no differences were found in mortality rate. Likewise, a relationship seems to exist among age and the range of anticoagulation [49,51,52].…”

Section: Antiplatelet Therapymentioning

confidence: 87%

Oral anticoagulant treatment: Risk factors involved in 500 intracranial hemorrhages

Cantalapiedra

Gutiérrez

Tortosa

et al. 2006

J Thromb Thrombolysis

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Intracranial bleeding is the most severe complication caused by anticoagulant or antiplatelet treatment. The increasing use of this therapy, especially in older people, makes the balance between clinical benefit and bleeding risk an important consideration. A retrospective study of all consecutive 500 intracranial hemorrhages in the West Valladolid area, approximately 220,000 people, during the period 1998 to 2004, was performed. In relation to mortality, predisposing conditions were included, such as age, antithrombotic treatment, arterial hypertension, cancer, blood diseases, vascular malformations, and traumatisms. The incidence of intracranial hemorrhage was 310 per 100,000 per year with a mortality of 30%. Higher mortality was found in antiplatelet-treated patients (44.9%) than in anticoagulated patients (31.1%). This may be related to a different mean age of 78 vs. 71 years. Arterial hypertension was the most frequent risk factor (45.1% in nontreated patients, 60% anticoagulated, and 75.5% antiplatelet). The relative risk of intracranial bleeding in anticoagulated patients was 11.2 (p < 0.001) with an incidence of 0.03% and a median of 14 months since treatment began. The median INR was 3.3. In 40% of the patients the previous five controls were in range. Strict consideration of indications criteria joined to a better control of risk factors may avoid intracranial bleeding episodes.

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“…Aspirin has been associated with an increased incidence of blood transfusion in trauma patients, most often in the orthopedic literature (12). In a retrospective study of patients aged Ͼ 60 years with mild to moderate head trauma, however, there was no association between aspirin use and an increased risk of significant intracranial hemorrhage (13). Conversely, clopidogrel use has been associated with an increased incidence of cranial surgery, episodes of rebleeding, and transfusion requirement among head trauma patients aged Ն 50 years (14).…”

Section: Discussionmentioning

confidence: 98%