Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel

A prospective analysis

Bellal Joseph, Viraj Pandit, Hassan Aziz, Narong Kulvatunyou, Ammar Hashmi, Andrew Tang, Terence OKeeffe, Julie Wynne, Gary Vercruysse, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)817-820
Number of pages4
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number3
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

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clopidogrel
Head
Tomography
Craniocerebral Trauma
Abbreviated Injury Scale
Platelet Transfusion
Glasgow Coma Scale
Injury Severity Score
Intracranial Hemorrhages
Odds Ratio
Confidence Intervals
Traumatic Intracranial Hemorrhage
Traumatic Brain Injury
Therapeutics
Propensity Score

Keywords

  • Clopidogrel therapy
  • Neurosurgical intervention
  • Progression on repeat head computed tomography

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel : A prospective analysis. / Joseph, Bellal; Pandit, Viraj; Aziz, Hassan; Kulvatunyou, Narong; Hashmi, Ammar; Tang, Andrew; OKeeffe, Terence; Wynne, Julie; Vercruysse, Gary; Friese, Randall S.; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 3, 01.03.2014, p. 817-820.

Research output: Contribution to journalArticle

Joseph, B, Pandit, V, Aziz, H, Kulvatunyou, N, Hashmi, A, Tang, A, OKeeffe, T, Wynne, J, Vercruysse, G, Friese, RS & Rhee, P 2014, 'Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: A prospective analysis', Journal of Trauma and Acute Care Surgery, vol. 76, no. 3, pp. 817-820. https://doi.org/10.1097/TA.0b013e3182aafcf0
Joseph, Bellal ; Pandit, Viraj ; Aziz, Hassan ; Kulvatunyou, Narong ; Hashmi, Ammar ; Tang, Andrew ; OKeeffe, Terence ; Wynne, Julie ; Vercruysse, Gary ; Friese, Randall S. ; Rhee, Peter. / Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel : A prospective analysis. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 3. pp. 817-820.
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abstract = "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.",
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AU - Joseph, Bellal

AU - Pandit, Viraj

AU - Aziz, Hassan

AU - Kulvatunyou, Narong

AU - Hashmi, Ammar

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Wynne, Julie

AU - Vercruysse, Gary

AU - Friese, Randall S.

AU - Rhee, Peter

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N2 - 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.

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