Predicting intracranial lesions by antiplatelet agents in subjects with mild head injury

Fabbri, Andrea; Servadei, Franco; Marchesini, Giulio; Stein, Sherman C.; Vandelli, Alberto

doi:10.1136/jnnp.2009.197467

Cited by 39 publications

(18 citation statements)

References 31 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 These data were only partially confirmed because, in our study, the use of antiplatelet agents clearly interacted with age in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 63%

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Iaccarino¹,

Schiavi²,

Picetti

et al. 2014

JNS

View full text Add to dashboard Cite

Object Traumatic parenchymal mass lesions are common sequelae of traumatic brain injuries (TBIs). They occur in up to 8.2% of all TBI cases and 13%–35% of severe TBI cases, and they account for up to 20% of surgical intracranial lesions. Controversy exists concerning the association between radiological and clinical evolution of brain contusions. The aim of this study was to identify predictors of unfavorable outcome, analyze the evolution of brain contusions, and evaluate specific indications for surgery. Methods In a retrospective, multicenter study, patients with brain contusions were identified in separate patient cohorts from 11 hospitals over a 4-year period (2008–2011). Data on clinical parameters and course of the contusion were collected. Radiological parameters were registered by using CT images taken at the time of hospital admission and at subsequent follow-up times. Patients who underwent surgical procedures were identified. Outcomes were evaluated 6 months after trauma by using the Glasgow Outcome Scale-Extended. Results Multivariate analysis revealed the following reliable predictors of unfavorable outcome: 1) increased patient age, 2) lower Glasgow Coma Scale score at first evaluation, 3) clinical deterioration in the first hours after trauma, and 4) onset or increase of midline shift on follow-up CT images. Further multivariate analysis identified the following as statistically significant predictors of clinical deterioration during the first hours after trauma: 1) onset of or increase in midline shift on follow-up CT images (p < 0.001) and 2) increased effacement of basal cisterns on follow-up CT images (p < 0.001). Conclusions In TBI patients with cerebral contusion, the onset of clinical deterioration is predictably associated with the onset or increase of midline shift and worsened status of basal cisterns but not with hematoma or edema volume increase. A combination of clinical deterioration and increased midline shift/basal cistern compression is the most reasonable indicator for surgery.

show abstract

“…11 These data were only partially confirmed because, in our study, the use of antiplatelet agents clearly interacted with age in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 63%

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Iaccarino¹,

Schiavi²,

Picetti

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…Nonetheless, the mortality rate of subjects receiving aspirin was also reported to be higher than normal [33]. In cases observed in EDs, pre-injury antiplatelet therapy was recently shown to increase significantly the risk of intracranial lesions in subjects after mild head injury [34], whereas in a prospective study of mild and moderate head injury in subjects more than 60 years old, low-dose aspirin prophylaxis had no effect on the frequency or types of intracerebral or meningeal hemorrhage [35]. The initial size of the contusion and the presence of SDH were selected as predictors of radiological progression, and the initial GCS and younger age as predictors of good disposition at discharge [34], but much more evidence is required before a firm conclusion can be drawn.…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

“…The journal strives to identify key new developments and potential future discoveries in the constantly changing world of neuroscience. Traversing the realm of clinical neuroscience, we hope to uncover the citation classics of the future,8–17 while at the same time, catering to a more general audience with teaching and wider instruction in mind 18 19. Despite the challenges of an ever-changing medical publishing landscape, with the need to adapt and remain fresh (including the launch of our new cover image with this issue), we look forward to sharing the trail blazers with you over the coming year.…”

Section: Medical Publishing Metrics and Financial Yieldsmentioning

confidence: 99%

Lies, damned lies… and citation metrics

Kiernan

2012

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

Predicting intracranial lesions by antiplatelet agents in subjects with mild head injury

Abstract: SUMMARYBackground: The effect of pre-injury antiplatelet treatment in the risk of intracranial lesions in

Cited by 39 publications

References 31 publications

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study

Lies, damned lies… and citation metrics

Contact Info

Product

Resources

About