The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury

Han, Hokyun; Koh, Eun Jung; Choi, Hye Won; Kim, Byong-Cheol; Yang, Seung Dae; Cho, Keun-Tae

doi:10.13004/kjnt.2016.12.2.61

Cited by 10 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 Furthermore, no difference in 7-day mortality rates with respect to AP intake was noted for patients undergoing decompressive hemicraniectomy. 11 This data is consistent with our results, which indicates that although patients suffering postoper-ative bleeding have higher mortality rates, postoperative bleeding does not appear to be directly affected by the preoperative intake of AP/AC medications.…”

Section: Mortality Rates In Tbi Patients Treated With Ap/acsupporting

confidence: 92%

“…A study by Han et al showed a postoperative bleeding rate of 52.5% after decompressive craniectomy for TBI in patients treated with AP therapy. 11 The rate described is higher than in our cohort, however they only included patients undergoing hemicraniectomy with a midline shift > 5 mm. AP treatment was shown to be associated with higher mortality rates in TBI.…”

Section: Management Of Ap/ac Treatment In Neurosurgical Patientsmentioning

confidence: 59%

“…7 Studies on the management of neurosurgical patients treated with AP or AC therapy undergoing craniotomy, especially in the setting of TBI, are sparse. 6,11,20,22,25,27 The aim of this study was to analyze hemorrhagic complications in patients treated with AP or AC therapy undergoing craniotomy due to TBI.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic complications in patients with traumatic brain injury undergoing craniotomy or craniectomy

Greuter

Ullmann

Mariani

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVETraumatic brain injury (TBI) is common among the elderly, often treated with antiplatelet (AP) or anticoagulation (AC) therapy, creating new challenges in neurosurgery. In contrast to elective craniotomy, in which AP/AC therapy is mostly discontinued, in TBI usually no delay in treatment can be afforded. The aim of this study was to analyze the effect of AP/AC therapy on postoperative bleeding after craniotomy/craniectomy in TBI.METHODSPostoperative bleeding rates in patients treated with AP/AC therapy (blood thinner group) and in those without AP/AC therapy (control group) were retrospectively compared. Furthermore, univariate and multivariate analyses were conducted to identify risk factors for postoperative bleeding. Lastly, a proportional Cox regression analysis comparing postoperative bleeding events within 14 days in both groups was performed.RESULTSOf 143 consecutive patients undergoing craniotomy/craniectomy for TBI between 2012 and 2017, 47 (32.9%) were under AP/AC treatment. No significant difference for bleeding events was observed in univariate (40.4% blood thinner group vs 36.5% control group; p = 0.71) or Cox proportional regression analysis (log rank χ2 = 0.29, p = 0.59). Patients with postoperative bleeding showed a significantly higher mortality rate (p = 0.035). In the univariate analysis, hemispheric lesion, acute subdural hematoma, hematological disease, greater extent of midline shift, and pupillary difference were significantly associated with a higher risk of postoperative bleeding. However, in the multivariate regression analysis none of these factors showed a significant association with postoperative bleeding.CONCLUSIONSPatients treated with AP/AC therapy undergoing craniotomy/craniectomy due to TBI do not appear to have increased rates of postoperative bleeding. Once postoperative bleeding occurs, mortality rates rise significantly.

show abstract

Section: Mortality Rates In Tbi Patients Treated With Ap/acsupporting

confidence: 92%

Section: Management Of Ap/ac Treatment In Neurosurgical Patientsmentioning

confidence: 59%

See 1 more Smart Citation

Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic complications in patients with traumatic brain injury undergoing craniotomy or craniectomy

Greuter

Ullmann

Mariani

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…In patients with blunt head trauma, a previous meta-analysis of case-control and cohort studies showed only a slight and non-significant increased risk of death in patients who were taking pre-injury APA [ 790 ]. Further studies found both an association with worsening of the lesion [ 791 , 792 ], need for neurosurgical intervention [ 791 ], prolonged hospital stay and increased rate of disability [ 793 ], or no influence on survival [ 794 , 795 ], neurological outcome [ 786 , 796 ], need for neurosurgical intervention [ 794 , 797 ], haemorrhagic complications and need of re-operation after decompressive craniectomy [ 798 ], questioning the need for routine neurosurgical consultation [ 797 ] or repeat CT [ 799 ] in cases of mild head trauma or low-altitude falls in patients treated with APA (mainly aspirin, clopidogrel or both).…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

View full text Add to dashboard Cite

Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reexamined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

show abstract

“…Thirty-eight were selected for full-text analysis of which 19 were excluded as they did not fulfill the inclusion criteria. Finally, 20 studies were included in this review (16)(17)(18)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). Characteristics of included studies are presented in Table 1.…”

Section: Details Of Search and Included Studiesmentioning

confidence: 99%

The Impact of Preinjury Use of Antiplatelet Drugs on Outcomes of Traumatic Brain Injury: A Systematic Review and Meta-Analysis

2022

View full text Add to dashboard Cite

ObjectiveThe study aimed to compare outcomes of traumatic brain injury (TBI) in patients on pre-injury antiplatelet drugs vs. those, not on any antiplatelet or anticoagulant drugs.MethodsPubMed, Embase, and Google Scholar databases were searched up to 15th May 2021. All cohort studies comparing outcomes of TBI between antiplatelet users vs. non-users were included.ResultsTwenty studies were included. On comparison of data of 2,447 patients on pre-injury antiplatelet drugs with 4,814 controls, our analysis revealed no statistically significant difference in early mortality between the two groups (OR: 1.30 95% CI: 0.85, 1.98 I2 = 80% p = 0.23). Meta-analysis of adjusted data also revealed no statistically significant difference in early mortality between antiplatelet users vs. controls (OR: 1.24 95% CI: 0.93, 1.65 I2 = 41% p = 0.14). Results were similar for subgroup analysis of aspirin users and clopidogrel users. Data on functional outcomes was scarce and only descriptive analysis could be carried out. For the need for surgical intervention, pooled analysis did not demonstrate any statistically significant difference between the two groups (OR: 1.11 95% CI: 0.83, 1.48 I2 = 55% p = 0.50). Length of hospital stay (LOS) was also not found to be significantly different between antiplatelet users vs. non-users (MD: −1.00 95% CI: −2.17, 0.17 I2 = 97% p = 0.09).ConclusionOur results demonstrate that patients on pre-injury antiplatelet drugs do not have worse early mortality rates as compared to patients, not on any antiplatelet or anticoagulant drugs. The use of antiplatelets is not associated with an increased need for neurosurgical intervention and prolonged LOS.

show abstract

The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury

Cited by 10 publications

References 20 publications

Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic complications in patients with traumatic brain injury undergoing craniotomy or craniectomy

Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic complications in patients with traumatic brain injury undergoing craniotomy or craniectomy

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The Impact of Preinjury Use of Antiplatelet Drugs on Outcomes of Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About