159 Antiplatelet Therapy After Traumatic Intracranial Hemorrhage

Le résumé fourni par la source

INTRODUCTION: Anti-platelet therapy (APT) after traumatic intracranial hemorrhage is a challenging and highly controversial situation, as the risk of hemorrhage progression must be weighed against the risk of thrombotic events. Currently, no data exist to guide clinicians. METHODS: We retrospectively identified all patients admitted to our institution with traumatic intracranial hemorrhage that received aspirin or clopidogrel during their initial hospitalization over a 3-year period. We reviewed their demographics, hospital course, APT indication, timing of APT initiation relative to the trauma, and complications. RESULTS: A total of 223 patients were identified. The median age and Glasgow Coma Scale score of these patients was 61 and 13, respectively. Forty-eight (21.52%) patients required invasive neurosurgical procedures including intracranial pressure (ICP) monitors and/or open surgeries. Ninety-two patients (41.3%) received these medications because of previous APT use with a high thrombotic risk, and 86 patients (38.6%) had blunt cerebrovascular injuries. The median time from injury to starting APT was 4 days. Immediate complications including new hemorrhage or previous hemorrhage progression occurred in 6 (2.7%) patients, and 3 (1.4%) of these patients required a neurosurgical intervention. Delayed complications including progression of acute to chronic subdural hematoma (SDH) that required an operative intervention occurred in 5 (3.9%) patients. Thrombotic events occurred in 21 (9.4%) patients prior to starting APT. Thirteen (5.8%) of these events were potentially preventable because an APT indication existed, but the medications were withheld due to a perceived intracranial hemorrhage risk. CONCLUSION: For this patient population, the immediate and delayed intracranial hemorrhage risk from APT therapy must be weighed against the consequences of withholding these medications. Although further studies are in progress, our retrospective review provides the first complication rates for APT in traumatic intracranial hemorrhage patients.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.