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

Cheng, Li; Cui, Gaoliang; Yang, Rong

doi:10.3389/fneur.2022.724641

Cited by 8 publications

(4 citation statements)

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“…However, the subgroup of patients on dual antiplatelet therapy had an increased delayed bleeding risk, compared with single APA patients [ 364 ]. Another meta-analysis that included 20 observational studies comparing 2447 TBI patients on pre-injury APAs with 4814 controls revealed no statistically significant difference in early mortality, need for neurosurgery or LOS between the two groups, with similar results for subgroup analyses of aspirin and clopidogrel users [ 365 ].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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Background Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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“…With this regard, several authors emphasise that anti-platelets vs. anticoagulants, and amongst the latter, VKAs vs. DOACs, are at higher risk (4,13,22,(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Use of the Canadian CT head rule for patients on anticoagulant/anti-platelet therapy presenting with mild traumatic brain injury: prospective observational study

Uccella,

Riboni,

Polinelli

et al. 2024

Front. Neurol.

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Background and importanceMild traumatic brain injury (mTBI) is a frequent presentation in Emergency Department (ED). There are standardised guidelines, the Canadian CT Head Rule (CCHR), for CT scan in mTBI that rule out patients on either anticoagulant or anti-platelet therapy. All patients with these therapies undergo a CT scan irrespectively of other consideration.ObjectiveTo determine whether standard guidelines could be applied to patients on anticoagulants or anti-platelet drugs.Design, settings, and participants1,015 patients with mTBI and Glasgow Coma Score (GCS) of 15 were prospectively recruited, 509 either on anticoagulant or anti-platelet therapy and 506 on neither. All patients on neither therapy underwent CT scan following guidelines. All patients with mTBI on either therapy underwent CT scan irrespective of the guidelines.Outcome measure and analysisPrimary endpoint was the incidence of post-traumatic intracranial bleeding in patients either on anticoagulants or anti-platelet drugs and in patients who were not on these therapies. Bayesian statistical analysis with calculation of Confidence Intervals (CI) was then performed.Main resultsSixty scans were positive for bleeding: 59 patients fulfilled the criteria and 1 did not. Amongst patients with haemorrhage, 24 were on either therapy and only one did not meet the guidelines but in this patient the CT scan was performed before 2 h from the mTBI. Patients on either therapy did not have higher bleeding rates than patients on neither. There were higher bleeding rates in patients on anti-platelet therapy who met the guidelines vs. patients who did not. These rates overlapped with patients on neither therapy, meeting CCHR.ConclusionThe CCHR might be used for mTBI patients on either therapy. Anticoagulants and anti-platelet drugs should not be considered a risk factor for patients with mTBI and a GCS of 15. Multicentric studies are needed to confirm this result.

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“…Eine aktuelle Metaanalyse zeigte, dass die Einnahme von Thrombozytenaggregationshemmern keinen Einfluss auf die frühe Sterblichkeitsrate bei Patienten mit SHT hatte. Es konnte auch kein Unterschied zwischen Clopidogrel und Aspirin hinsichtlich ihrer Auswirkungen auf die Sterblichkeit bei SHT-Patienten gefunden werden [48].…”

Section: Merkeunclassified

Anästhesiologisches Management bei Schädel-Hirn-Trauma

Hein,

Blancke,

Schaller

2024

Anästhesiol Intensivmed Notfallmed Schmerzther

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

Cited by 8 publications

References 50 publications

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

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

Use of the Canadian CT head rule for patients on anticoagulant/anti-platelet therapy presenting with mild traumatic brain injury: prospective observational study

Anästhesiologisches Management bei Schädel-Hirn-Trauma

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