Antiplatelet agents, warfarin, and epidemic intracranial hemorrhage.
BACKGROUND
Atrial fibrillation prophylaxis with warfarin and strong antiplatelet agent use in cardiovascular diseases has increased the incidence of anticoagulation in the elderly. We studied traumatic intracranial hemorrhage (TICH) in patients ≥55 years of age on anticoagulation and antiplatelet agents in a stable population.


METHODS
We used a Level 1 Trauma Center registry study comparing TICH in patients on anticoagulation drugs during the index periods 1999 to 2000 (T1) and 2007 to 2008 (T2).


RESULTS
A total of 526 TICH patients were seen in T1 and T2 (age, 77.6 vs 77.5 years; not significant [NS]), with the rate doubling from 6.2% to 12.3% of all trauma activations (P < .01). There was no increase in atrial fibrillation, warfarin use, or CHADS(2) scores in atrial fibrillation patients on anticoagulation therapy. TICH in patients taking antiplatelet agents increased 5-fold (2.2 % vs 10.3%; P < .01). Overall TICH mortality rate was the same (12.4% vs 12.2%, NS). TICH mortality among patients on therapeutic warfarin was greater in T1 (26%; P < .05), but mortality was similar to TICH in patients not on anticoagulants in T2 (19% vs 12.2%, NS), suggesting treatment improved. Prevalence and mortality of TICH in patients on antiplatelet agents were similar to TICH in patients on warfarin.


CONCLUSIONS
TICH in patients on anticoagulants is epidemic in patients ≥55 years of age. Despite national trends, our well-served population has not seen an increase in warfarin use for atrial fibrillation. Instead, use of antiplatelet agents has increased and is associated with an increased incidence of TICH.
Siracuse
Jeffrey J
JJ
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Robich
Michael P
MP
Gautam
Shiva
S
Kasper
Ekkehard M
EM
Moorman
Donald W
DW
Hauser
Carl J
CJ
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D020198:Intracranial Hemorrhage, Traumatic / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D015995:Prevalence; D012042:Registries; D014652:Vascular Diseases / Q000188:drug therapy*; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin