Highlights from #AASTAnnualMeeting - TBI in patients with Antiplatelet therapy

Former resident John Cull presented some of our data on patients with aspirin or plavix who sustain a blunt head injury.  

OUTCOMES IN TRAUMATIC BRAIN INJURY FOR PATIENTS PRESENTING ON ANTIPLATELET THERAPY

John D. Cull MD, Lauren Sakai MD, Brent Johnson MS, Imran Sabir BS, Andrew Tully BS, Kimberly Nagy* MD, Andrew Dennis DO, Frederic Starr MD, Kimberly Joseph* MD, Dorion Wiley MD, Henry R. Moore III, MD, Uretz J. Oliphant* MD, Faran Bokhari

MD, Cook County Hospital, Department of Trauma

Introduction: As the population ages, a growing number of patients are presenting to trauma units with head injuries while on anti-platelet therapy (APT). The influence of APT on these patients is poorly defined. This study examines the outcomes of patients on APT presenting to the hospital with blunt head trauma (BHT).

Methods: The registries of two level I trauma centers were reviewed for patients over 40 years of age presenting from January 2008 to December 2011 with BHT. Patients on APT were compared to patients presenting with BHT not on APT. The primary outcome measures were in-hospital mortality, intracranial hemorrhage (ICH) and need for neurosurgical intervention. Hospital length of stay (LOS) was reviewed as a secondary outcome measure. Both crude and multivariate-adjusted logistic regression models were fit to estimate odds ratios and 95% confidence intervals. Adjusted models included antiplatelet status as well as age, injury severity score (ISS) and Glasgow coma score (GCS).

Results: All patients meeting inclusion criteria and having complete data (n=1547) were included in the analytic cohort ; 422 (27%) of these patients were taking APT [aspirin, n=330; clopidogrel, n = 36; aspirin and clopidogrel, n = 56]. Overall rates of ICH, neurosurgical intervention and in-hospital mortality of patients with BHT in our study were 45.4%, 3.1% and 5.8%, respectively. Controlling for age, ISS and GCS, there was no significant difference in ICH (OR=0.84, 95% CI: 0.61-1.16), neurosurgical intervention (OR=1.26, 95% CI: 0.60-2.67), or mortality (OR=1.79 95% CI: 0.89-3.59) associated with APT. Subgroup analysis revealed that among more severely injured patients (ISS ≥ 20), those on APT had elevated odds of in-hospital mortality (OR=2.34, 95% CI: 1.03-5.31) compared with non-users. Prolonged hospitalization (LOS>14 days) was more likely in the APT group than those in the non APT group (OR=1.85, 1.09-3.12).

Conclusion: This is the largest study examining the effects of APT on outcomes in BHT. While the effects of anti-platelet therapy in BHT patients aged 40 years and older showed no significant difference in ICH, neurosurgical intervention and in-hospital mortality, older and more severely injured patients on APT may carry an increased risk of poor outcome when compared with non-APT patients. Larger studies are needed to appropriately assess the effects of antiplatelet therapy on BHT outcomes in these populations.