title: Use of anti-platelet agents after traumatic intracranial hemorrhage.
abstract: OBJECTIVE
  To evaluate the risk of hemorrhagic complications associated with starting anti-platelet therapy (APT) after acute traumatic intracranial hemorrhage (tICH) and to examine the frequency of thrombotic complications.
  
  
  METHODS
  We retrospectively identified all patients admitted to our institution with tICH that received APT during their initial hospitalization over a three-year period. We reviewed their demographics, hospital course, clinical indication and timing for initiation of APT, and complications.
  
  
  RESULTS
  A total of 222 patients were identified. The median age and Injury Severity Score (ISS) was 61 and 21, respectively. Fifty (23%) patients required neurosurgical procedures. APTs were initiated due to a history of APT use in 91 patients (41%) and blunt cerebrovascular injury in 86 patients (38.6%). The median time from injury to starting APT was 4 days. Immediate complications including new or worsening hemorrhage occurred in 1 (<1%) patient. Delayed hemorrhagic complications occurred in 6 (4.7%) patients. Thrombotic events occurred in 21 (9.4%) patients prior to starting APT. Thirteen (5.8%) of these were potentially preventable.
  
  
  CONCLUSIONS
  The risk of immediate and delayed intracranial hemorrhages from initiating APT after tICH must be weighed against the morbidity of delaying indicated thrombotic prophylaxis. Our initial data indicates that hemorrhagic complications are infrequent, and thrombotic complications can have significant clinical consequences. Our retrospective review provides the first rates of complications for this patient population.
authors.affiliation: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, TX, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Kerr
authors.affiliation: University of Utah School of Medicine, Department of Neurosurgery, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wilkerson
authors.affiliation: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, TX, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Shepard
authors.affiliation: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, TX, USA.
authors.forename: HuiMahn
authors.initials: H
authors.lastname: Choi
authors.affiliation: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, TX, USA. Electronic address: Ryan.S.Kitagawa@uth.tmc.edu.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kitagawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects*; D001930:Brain Injuries / Q000150:complications; D005260:Female; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000188:drug therapy*; D020300:Intracranial Hemorrhages / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D013927:Thrombosis / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Antiplatelet therapy; Blunt cerebral vascular injury; Neurotrauma; Traumatic intracranial hemorrhage