Antiplatelet Agents Tied to Traumatic Brain Hemorrhage

ACEP News
May 2010

By Richard Hyer
Elsevier Global Medical News


CHICAGO -- Increasing rates of traumatic intracranial hemorrhage in elderly patients appeared to be associated with the use of antiplatelet agents in a retrospective study of two different time periods.

The rise in traumatic intracranial hemorrhage (TICH) occurred without significant increases in diagnosis of atrial fibrillation or in use of Coumadin (warfarin), and overall mortality remained unchanged, Dr. Jeffrey J. Siracuse said at the annual meeting of the Central Surgical Association.

"Increased life expectancy and the rising prevalence of risk factors have led to increased atrial fibrillation nationwide," said Dr. Siracuse of Beth Israel Deaconess Medical Center, Boston.

"Patients with atrial fibrillation are at high risk for stroke and may also be at high risk for bleeding complications," he said. They often are treated with anticoagulants based on their CHADS2 scores, which are used to estimate risk of thromboembolism. This scoring system emphasizes warfarin prophylaxis.

The review of the hospital's trauma registry of 5,371 subjects examined records for all those admitted with intracranial hemorrhage during 1999-2000 (139 patients) and 2007-2008 (387 patients). Intracranial hemorrhages were considered traumatic if they were secondary to an external injury.

The mean age of patients in the 1999-2000 group and the 2007-2008 group was similar (about 77.5 years), and each group had about 50% men. The principal cause of trauma in both groups was a simple fall from standing. In the earlier group, 6.2% of all trauma admissions were TICH patients, but the number doubled to 12.3% in the later group.

The study found little increase in warfarin use over the two periods. However, the use of "strong antiplatelet agents, specifically clopidogrel and Aggrenox, increased fivefold between the two periods," said Dr. Siracuse. Also, in the earlier period, 27% of TICH patients were on aspirin, vs. 48% in the later period.

Dr. Siracuse reported no relevant financial interests. The study was sponsored by Beth Israel Deaconess, and the principal investigator was Dr. Carl J. Hauser.
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