Predictors of mortality in trauma patients with intracranial hemorrhage on preinjury aspirin or clopidogrel.
BACKGROUND
The mortality risk in elderly patients who sustained head trauma resulting in intracranial hemorrhage (ICH) while taking the antiplatelet agents aspirin (ASA) or clopidogrel or both (Plavix) was evaluated.


METHODS
A retrospective review identified trauma patients, age 50 or greater, who had computed tomography (CT) evidence of ICH and were taking ASA, clopidogrel, or a combination of both. Patient demographics, type of medication, mechanism of injury, Glasgow Coma Score (GCS), grading of head CT scans, and outcomes were characterized.


RESULTS
One hundred nine patients including 61 men and 48 women were identified; the mean age was 77 years +/- 10 years. Injury was due to level fall (73), fall from height (21), motor vehicle crash (11), and other (4). Twenty (18%) patients died; age, gender, type of medication, and mechanism of injury were not predictive of death. The initial GCS for survivors was 14.2 +/- 1.9 versus 11.3 +/- 4.9 for nonsurvivors (p < 0.007). Deaths based on initial CT grade were: grade 1, 5 of 70; grade 2, 4 of 17; grade 3, 5 of 10; grade 4, 6 of 12 (p = 0.002). Follow-up CT scans were performed in 81 patients who were not taken to surgery and had grade 1 or 2 hemorrhage initially. Of 4 patients with hemorrhage progression, there was 1 death (25%) versus 6 deaths in 77 patients without progression (8%; p = 0.70).


CONCLUSIONS
There is high mortality rate associated with ASA or clopidogrel or both in elderly patients who have head trauma resulting in ICH. The presenting GCS and initial grade of CT scan are most predictive of death. Progression of hemorrhage after admission is unusual. The risk of brain injury, particularly from falls, should be explained to elderly patients taking these medications.
Ivascu
Felicia A
FA
William Beaumont Hospital, Royal Oak, Michigan, USA. fivascu@beaumont.edu
Howells
Greg A
GA
Junn
Fredrick S
FS
Bair
Holly A
HA
Bendick
Phillip J
PJ
Janczyk
Randy J
RJ
D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality*; D016022:Case-Control Studies; D002423:Cause of Death; D000077144:Clopidogrel; D005260:Female; D015577:Geriatric Assessment; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers
D000925:Anticoagulants; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin