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Figures
Fig
Flow of patients in the study. Abbreviation: AC/AP, preinjury anticoagulant or antiplatelet.
Abstract
Study objective
The objective was to compare neurological outcomes at 6 months in older patients with preinjury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage with those without prior use of these medications.
Methods
This was a retrospective study conducted at a Level 1 trauma center from April 2009 to July 2010. Patients older than 55 years with isolated mild head injury (Glasgow Coma Scale score 13-15 and Abbreviated Injury Score < 3 in nonhead body region) were included. Demographic, clinical, and outcome data were abstracted from an existing traumatic brain injury database. The primary end point of unfavorable extended Glasgow Outcome Score at 6 months was compared between patients with and without preinjury warfarin or clopidogrel use.
Results
Seventy-seven eligible patients were identified: 27 (35%) with preinjury warfarin or clopidogrel use and 50 (65%) without. Baseline characteristics (sex, Glasgow Coma Scale score, Injury Severity Score, computed tomography score, and in-hospital mortality) were similar between cohorts, although the preinjury warfarin or clopidogrel cohort was older than the control group (P < .05). Patients in the preinjury warfarin or clopidogrel cohort were more likely to have an unfavorable outcome (16/27; 59.3%; 95% confidence interval, 40.7%-77.8%) as compared with those without (18/50; 36.0%; 95% confidence interval, 22.7%-49.3%) (P = .05).
Conclusion
Older adults with preinjury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage may be at an increased risk for unfavorable long-term neurological outcomes compared with similar patients without preinjury use of these medications.
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☆Source of funding: DN was supported through a Mentored Clinical Research Training Program Award (grant UL1TR000002 and linked award KL2TR000134 ) from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. NCATS and NIH had no role in the design and conduct of the study, in the analysis or interpretation of the data, or in the preparation of the data. The views expressed in this article are solely the responsibility of the authors and do not necessarily represent the official view of NCATS or NIH. Information on NCATS is available at http://www.ncats.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.
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