Are Antiplatelet and Anticoagulants Drugs A Risk Factor for Bleeding in Mild Traumatic Brain Injury?

Area of Science:

• Neurotrauma
• Clinical Neurology
• Emergency Medicine

Background:

• Mild traumatic brain injury (mTBI) necessitates decisions regarding computed tomography (CT) scans to rule out intracranial hemorrhage.
• Existing guidelines for mTBI lack consensus on managing patients using antiplatelet or anticoagulation drugs, especially with newer drug classes.
• Limited literature exists on the specific intracranial bleeding risks associated with these medications in mTBI patients.

Purpose of the Study:

• To evaluate the risk of intracranial bleeding in patients with mTBI who are on antiplatelet or anticoagulation therapy.
• To compare bleeding risks between patients on different drug regimens and the general population.
• To investigate potential differences in bleeding risk associated with second-generation antiplatelet and anticoagulant drugs.

Main Methods:

• A cohort of 2773 consecutive patients with mTBI was analyzed.
• Head CT scan results were evaluated, stratifying patients based on their anticoagulation and/or antiplatelet drug use.
• Analysis focused on patients with a Glasgow Coma Scale (GCS) score of 15.

Main Results:

• Of 1608 eligible patients (GCS 15), 517 were on antiplatelet drugs and 213 on anticoagulants.
• Patients on antiplatelet therapy exhibited a significantly higher risk of intracranial bleeding.
• Patients on anticoagulation showed a bleeding risk comparable to the general population; second-generation antiplatelets showed a trend toward higher bleeding risk.

Conclusions:

• Long-term anticoagulation therapy in mTBI patients with a GCS of 15 does not appear to increase intracranial hemorrhage risk.
• Antiplatelet therapy in mTBI patients with a GCS of 15 is associated with a higher propensity for intracranial bleeding.
• Second-generation antiplatelet drugs may further elevate this bleeding risk in mTBI patients.