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All those antiplatelet, anticoag stuff and head injury.

What is the evidence that they increase risk of significant intra-cranial event?

Prevalence of Intracranial Injury in Adult Patients With Blunt Head Trauma With and Without Anticoagulant or Antiplatelet Use. 1

Study:

  • Multicenter, prospective observational study in NY and LA.
    • 2007 to 2015 at 3 EDs in urban USA.
    • All adults with blunt trauma with CT. n=9070, 54ys, 61% M.
    • n=1323 on anti-plt or warfarin. 635 ASA, 109 Clopid, 406 Warfarin.

Findings:

  • For significant intracranial injury vs no agents. RR:
    • ASA alone: 1.3 (0.9 - 1.8)
    • Clop alone: 0.8 (0.2 - 2.3)
    • Warfarin alone: 1.9 (1.3 - 2.8)
    • ASA+Clop : 2.9 (1.5 - 5.4)

Conclusion:

'low threshold for neuroimaging in patients on Warfarin and combination ASA+Cloppy but not on their own.'

Systematic Review and Meta-analyses.

Systematic Review and Meta-Analysis: Is Pre-Injury Antiplatelet Therapy Associated With Traumatic Intracranial Hemorrhage? 2

A Meta-Analysis to determine the effect of preinjury antiplatelet agents on mortality in patients with blunt head trauma 3

  1. Probst MA, Gupta M, Hendey GW, Rodriguez RM, Winkel G, Loo GT, Mower WR - Ann Emerg Med - May 7, 2020; 75 (3); 354-364 PubMedID: 3195938 ↩

  2. van den Brand CL, Tolido T, Rambach AH, Hunink MG, Patka P, Jellema K. Systematic Review and Meta-Analysis: Is Pre-Injury Antiplatelet Therapy Associated with Traumatic Intracranial Hemorrhage?. J Neurotrauma. 2017;34(1):1-7. doi:10.1089/neu.2015.4393 ↩

  3. Batchelor JS, Grayson A. A meta-analysis to determine the effect of preinjury antiplatelet agents on mortality in patients with blunt head trauma. Br J Neurosurg. 2013;27(1):12-18. doi:10.3109/02688697.2012.705361 /home/nigel/Documents/GitHub/EBR/neuro/neuro_headinjury&AntiCoag.md ↩