title: Traumatic intracranial hemorrhage correlates with preinjury brain atrophy, but not with antithrombotic agent use: a retrospective study.
abstract: BACKGROUND
  The impact of antithrombotic agents (warfarin, clopidogrel, ASA) on traumatic brain injury outcomes is highly controversial. Although cerebral atrophy is speculated as a risk for acute intracranial hemorrhage, there is no objective literature evidence.
  
  
  METHODS
  This is a retrospective, consecutive investigation of patients with signs of external head trauma and age ≥60 years. Outcomes were correlated with antithrombotic-agent status, coagulation test results, admission neurologic function, and CT-based cerebral atrophy dimensions.
  
  
  RESULTS
  Of 198 consecutive patients, 36% were antithrombotic-negative and 64% antithrombotic-positive. ASA patients had higher arachidonic acid inhibition (p = 0.04) and warfarin patients had higher INR (p<0.001), compared to antithrombotic-negative patients. Antithrombotic-positive intracranial hemorrhage rate (38.9%) was similar to the antithrombotic-negative rate (31.9%; p = 0.3285). Coagulopathy was not present on the ten standard coagulation, thromboelastography, and platelet mapping tests with intracranial hemorrhage and results were similar to those without hemorrhage (p≥0.1354). Hemorrhagic-neurologic complication (intracranial hemorrhage progression, need for craniotomy, neurologic deterioration, or death) rates were similar for antithrombotic-negative (6.9%) and antithrombotic-positive (8.7%; p = 0.6574) patients. The hemorrhagic-neurologic complication rate was increased when admission major neurologic dysfunction was present (63.2% versus 2.2%; RR = 28.3; p<0.001). Age correlated inversely with brain parenchymal width (p<0.001) and positively with lateral ventricular width (p = 0.047) and cortical atrophy (p<0.001). Intracranial hemorrhage correlated with cortical atrophy (p<0.001) and ventricular width (p<0.001).
  
  
  CONCLUSIONS
  Intracranial hemorrhage is not associated with antithrombotic agent use. Intracranial hemorrhage patients have no demonstrable coagulopathy. The association of preinjury brain atrophy with acute intracranial hemorrhage is a novel finding. Contrary to antithrombotic agent status, admission neurologic abnormality is a predictor of adverse post-admission outcomes. Study findings indicate that effective hemostasis is maintained with antithrombotic therapy.
authors.affiliation: Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Dunham
authors.affiliation: Division of Cardiology, St. Elizabeth Health Center, Youngstown, Ohio, United States of America.
authors.forename: David A
authors.initials: DA
authors.lastname: Hoffman
authors.affiliation: Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Huang
authors.affiliation: CSL Behring, King of Prussia, Pennsylvania, United States of America.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Omert
authors.affiliation: Medical Education and Statistics, St. Elizabeth Health Center, Youngstown, Ohio, United States of America.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gemmel
authors.affiliation: Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America.
authors.forename: Renee
authors.initials: R
authors.lastname: Merrell
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D001284:Atrophy / Q000150:complications* / Q000503:physiopathology*; D001930:Brain Injuries / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology*; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D020198:Intracranial Hemorrhage, Traumatic / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors