Original Article

Impact of Preinjury Anticoagulation in Patients with Traumatic Brain Injury

Authors: Nasim Ahmed MD, FACS, Christie Bialowas MD, Yen-Hong Kuo ScM, MS, Leonard Zawodniak MD

Abstract

Introduction:This study was undertaken to examine the impact of various anticoagulation agents in head injury patients.Methods:The medical records and trauma registry were used to analyze the data. All adult trauma patients using aspirin, clopidogrel bisulfate (Plavix®), warfarin (Coumadin®), or heparin and admitted to the hospital with computed tomography (CT) scan evidence of brain injuries were included in the study. Patients were classified into three groups based on medication used.Results:From July 2004 through December 2006, 29 patients admitted to the trauma center were found to be on anticoagulation or antiplatelet agents. The control group consisted of 63 patients with CT evidence of head injury not on antiplatelet or anticoagulant medications. There were no significant differences among the groups regarding age, gender, Glasgow Coma Scale, Injury Severity Score, mortality (P = 0.65), ventilator days (P = 0.69), intensive care unit (ICU) days (P = 0.65), total hospital days (P = 0.41) or discharge disposition (P = 0.65).Conclusion:Prehead injury anticoagulation did not have any significant impact on outcomes.

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References

References1. Serebruany VL, Malinin AI, Jerome SD, et al. Effects of clopidogrel and aspirin combination versus aspirin alone on platelet aggregation and major receptor expression in patients with heart failure: the Plavix Use for Treatment Of Congestive Heart Failure (PLUTO-CHF) trial. Am Heart J 2003;146:713–720.SerebruanyVL]]MalininAI]]JeromeSD&etal;Effects of clopidogrel and aspirin combination versus aspirin alone on platelet aggregation and major receptor expression in patients with heart failure: the Plavix Use for Treatment Of Congestive Heart Failure (PLUTO-CHF) trial.Am Heart J2003146713-7202. Lavoie A, Ratte S, Clas D, et al. Preinjury warfarin use among elderly patients with closed head injuries in a trauma center. J Trauma 2004;56:802–807.LavoieA]]RatteS]]ClasD&etal;Preinjury warfarin use among elderly patients with closed head injuries in a trauma center.J Trauma200456802-8073. Cohen DB, Rinker C, Wilberger JE. Traumatic brain injury in anticoagulated patients. J Trauma 2006;60:553–557.CohenDB]]RinkerC]]WilbergerJETraumatic brain injury in anticoagulated patients.J Trauma200660553-5574. Franko J, Kish KJ, O'Connell BG, et al. Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma. J Trauma 2006;61:107–110.FrankoJ]]KishKJ]]O'ConnellBG&etal;Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma.J Trauma200661107-1105. Spektor S, Agus S, Merkin V, et al. 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. J Neurosurg 2003;99:661–665.SpektorS]]AgusS]]MerkinV&etal;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.J Neurosurg200399661-6656. Parris R, Hassan Z. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Does clopidogrel increase morbidity and mortality after minor head injury? Emerg Med J 2007;24:435–436.ParrisR]]HassanZTowards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Does clopidogrel increase morbidity and mortality after minor head injury?Emerg Med J200724435-4367. Marshall LF, Marshall SB, Klauber MR, et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 1992;9(suppl 1):S287–S292.MarshallLF]]MarshallSB]]KlauberMR&etal;The diagnosis of head injury requires a classification based on computed axial tomography.J Neurotrauma19929S287-S2928. Ajani UA, Ford ES, Greenland KJ, et al. Aspirin use among U.S. adults: behavioral risk factor surveillance system. Am J Prev Med 2006;30:74–77.AjaniUA]]FordES]]GreenlandKJ&etal;Aspirin use among U.S. adults: behavioral risk factor surveillance system.Am J Prev Med20063074-779. Mina AA, Bair HA, Howells GA, et al. Complications of preinjury warfarin use in the trauma patient. J Trauma 2003;54:842–847.MinaAA]]BairHA]]HowellsGA&etal;Complications of preinjury warfarin use in the trauma patient.J Trauma200354842-84710. Wojcik R, Cipolle MD, Seislove E, et al. Preinjury warfarin does not impact outcome in trauma patients. J Trauma 2001;51:1147–1151; discussion 1151–1152.11. Ohm C, Mina A, Howells G, et al. Effects of Antiplatelet agents on outcomes for elderly patients with traumatic intracranial hemorrhage. J Trauma 2005;58:518–522.OhmC]]MinaA]]HowellsG&etal;Effects of Antiplatelet agents on outcomes for elderly patients with traumatic intracranial hemorrhage.J Trauma200558518-522