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Published on: June 10, 2020
Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: a prospective analysis
Bellal Joseph1, Viraj Pandit, Hassan Aziz
1From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
Insights
Patients on preinjury clopidogrel therapy face higher risks of intracranial hemorrhage progression and neurosurgical intervention after head trauma. Routine repeat head CT scans are recommended for these patients.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Pharmacology
Background:
- Antiplatelet medications increase risk of traumatic intracranial hemorrhage after head trauma.
- Previous studies broadly categorized antiplatelet drugs, limiting specific insights.
- Clopidogrel, a common antiplatelet, warrants specific investigation regarding its impact on traumatic brain injury outcomes.
Purpose of the Study:
- To evaluate clinical outcomes in patients with traumatic brain injury (TBI) on preinjury clopidogrel therapy.
- To determine the necessity of repeat head computed tomography (RHCT) in patients using clopidogrel before injury.
- To assess the association between clopidogrel use and neurosurgical intervention requirements.
Main Methods:
- Prospective enrollment of patients with TBI and intracranial hemorrhage on initial head CT.
- Propensity score matching (1:1 ratio) of clopidogrel users with a control group without antiplatelet/anticoagulation therapy.
- Outcome measures included RHCT progression and need for neurosurgical intervention, controlling for age, GCS, AIS, ISS, and platelet transfusion.
Main Results:
- 142 patients (71 clopidogrel, 71 control) were analyzed; mean age 70.5 years, 66% male, median GCS 14.
- Patients on preinjury clopidogrel showed significantly higher odds of hemorrhage progression on RHCT (OR 5.1) and RHCT due to deterioration (OR 2.1).
- Clopidogrel users had increased odds of requiring neurosurgical intervention (OR 1.8).
Conclusions:
- Preinjury clopidogrel therapy is an independent risk factor for intracranial hemorrhage progression and need for neurosurgical intervention in TBI patients.
- Routine RHCT scans should be considered for patients with TBI who were on preinjury clopidogrel.
- This finding highlights the importance of considering specific antiplatelet agents in trauma risk stratification.
Background:
Patients receiving antiplatelet medications are considered to be at an increased risk for traumatic intracranial hemorrhage after blunt head trauma. However, most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate clinical outcomes and the requirement of a repeat head computed tomography (RHCT) in patients on preinjury clopidogrel therapy.
Methods:
Patients with traumatic brain injury with intracranial hemorrhage on initial head CT were prospectively enrolled. Patients on preinjury clopidogrel were matched with patients exclusive of antiplatelet and anticoagulation therapy using a propensity score in a 1:1 ratio for age, Glasgow Coma Scale (GCS), head Abbreviated Injury Scale (h-AIS), Injury Severity Score (ISS), neurologic examination, and platelet transfusion. Outcome measures were progression on RHCT scan and need for neurosurgical intervention.
Results:
A total of 142 patients with intracranial hemorrhage on initial head CT scan (clopidogrel, 71; no clopidogrel, 71) were enrolled. The mean (SD) age was 70.5 (15.1) years, 66% were male, median GCS score was 14 (range, 3-15), and median h-AIS (ISS) was 3 (range, 2-5). The mean (SD) platelet count was 210 (101), and 61% (n = 86) of the patients received platelet transfusion. Patients on preinjury clopidogrel were more likely to have progression on RHCT (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.1-7.1) and RHCT as a result of clinical deterioration (OR, 2.1; 95% CI, 1.8-3.5). The overall rate of neurosurgical intervention was 4.2% (n = 6). Patients on clopidogrel therapy were more likely to require a neurosurgical intervention (OR, 1.8; 95% CI, 1.4-3.1).
Conclusion:
Preinjury clopidogrel therapy is associated with progression of initial insult on RHCT scan and need for neurosurgical intervention. Preinjury clopidogrel therapy as an independent variable should warrant the need for a routine RHCT scan in patients with traumatic brain injury.
Level Of Evidence:
Prognostic study, level I; therapeutic study, level II.
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