A meta-analysis to determine the effect of preinjury antiplatelet agents on mortality in patients with blunt head trauma.
BACKGROUND
Anticoagulation abnormalities have been recognized for several decades as potential risk factors for increasing the risk of traumatic intracranial haemorrhage in patients with blunt head trauma. The potential increased risk of death as a consequence has not been fully evaluated. The aim of the study was to perform a meta-analysis in order to evaluate based upon the current level of evidence whether the use of pre-injury aspirin or clopidogrel increases the risk of mortality in patients with blunt head trauma.


METHODS
The databases Medline and EMBASE were searched via the Ovid interface. The Medline database was also searched using the PubMed interface. Case control studies or nested case control studies were identified comparing mortality rates on patients with blunt head trauma in patients on aspirin or clopidogrel against patients not on antiplatelet agents.


RESULTS
Five studies in total were identified as suitable for the meta-analysis. Four of these studies were suitable for the aspirin meta-analysis and four for the clopidogrel meta-analysis. The common odds ratio for the aspirin meta-analysis using the Random Effects model was found to be 2.435 (95% CI: 0.637-9.314). Significant heterogeneity was present I(2) = 79.521. The common odds ratio for the clopidogrel meta-analysis using the Random Effects model was found to be 1.554 (95% CI: 0.320-7.536). Significant heterogeneity was present I(2) = 69.090.


CONCLUSIONS
In summary, this meta-analysis showed a slight increased risk of death in patients with blunt head trauma who were taking pre-injury antiplatelet agents although the results did not reach statistical significance. In view of the small number of low level studies from which this meta-analysis is based, further work is required in this area.
Department of Emergency Medicine, Manchester Royal Infirmary Foundation Trust, Oxford Road, Manchester, England. johnbatchelor@msn.com
John Stephen
JS
Batchelor
Alan
A
Grayson
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000139:chemically induced; D000077144:Clopidogrel; D004812:Epidemiologic Methods; D016489:Head Injuries, Closed / Q000401:mortality*; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000139:chemically induced / Q000401:mortality*; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin