title: Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: a prospective analysis.
abstract: BACKGROUND
  Patients receiving antiplatelet medications are considered to be at an increased risk for traumatic intracranial hemorrhage after blunt head trauma. However, most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate clinical outcomes and the requirement of a repeat head computed tomography (RHCT) in patients on preinjury clopidogrel therapy.
  
  
  METHODS
  Patients with traumatic brain injury with intracranial hemorrhage on initial head CT were prospectively enrolled. Patients on preinjury clopidogrel were matched with patients exclusive of antiplatelet and anticoagulation therapy using a propensity score in a 1:1 ratio for age, Glasgow Coma Scale (GCS), head Abbreviated Injury Scale (h-AIS), Injury Severity Score (ISS), neurologic examination, and platelet transfusion. Outcome measures were progression on RHCT scan and need for neurosurgical intervention.
  
  
  RESULTS
  A total of 142 patients with intracranial hemorrhage on initial head CT scan (clopidogrel, 71; no clopidogrel, 71) were enrolled. The mean (SD) age was 70.5 (15.1) years, 66% were male, median GCS score was 14 (range, 3-15), and median h-AIS (ISS) was 3 (range, 2-5). The mean (SD) platelet count was 210 (101), and 61% (n = 86) of the patients received platelet transfusion. Patients on preinjury clopidogrel were more likely to have progression on RHCT (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.1-7.1) and RHCT as a result of clinical deterioration (OR, 2.1; 95% CI, 1.8-3.5). The overall rate of neurosurgical intervention was 4.2% (n = 6). Patients on clopidogrel therapy were more likely to require a neurosurgical intervention (OR, 1.8; 95% CI, 1.4-3.1).
  
  
  CONCLUSIONS
  Preinjury clopidogrel therapy is associated with progression of initial insult on RHCT scan and need for neurosurgical intervention. Preinjury clopidogrel therapy as an independent variable should warrant the need for a routine RHCT scan in patients with traumatic brain injury.
  
  
  METHODS
  Prognostic study, level I; therapeutic study, level II.
authors.affiliation: From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Ammar
authors.initials: A
authors.lastname: Hashmi
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Julie
authors.initials: J
authors.lastname: Wynne
authors.forename: Gary
authors.initials: G
authors.lastname: Vercruysse
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D015998:Abbreviated Injury Scale; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D000077144:Clopidogrel; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D020198:Intracranial Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D059906:Neuroimaging; D063868:Patient Outcome Assessment; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D057216:Propensity Score; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine