gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Prior anticoagulation or antiplatelet use affects intracranial hemorrhage pattern and patient's outcome after traumatic brain injuries

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  • Tareq A. Juratli - Klinik und Polikinik für Neurochirurgie, Carl Gustav Carus Universitätsklinik, dn der Technischen Universität Dresden
  • Benedikt Zang - Klinik und Polikinik für Neurochirurgie, Carl Gustav Carus Universitätsklinik, dn der Technischen Universität Dresden
  • Rainer Litz - Klinik für Anästhesiologie, Intensiv- und Schmerztherapie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Dresden
  • Kerim-Hakan Sitoci - Klinik und Polikinik für Neurochirurgie, Carl Gustav Carus Universitätsklinik, dn der Technischen Universität Dresden
  • Johann Klein - Klinik und Polikinik für Neurochirurgie, Carl Gustav Carus Universitätsklinik, dn der Technischen Universität Dresden
  • Gabriele Schackert - Klinik und Polikinik für Neurochirurgie, Carl Gustav Carus Universitätsklinik, dn der Technischen Universität Dresden
  • Stephan B Sobottka - Klinik und Polikinik für Neurochirurgie, Carl Gustav Carus Universitätsklinik, dn der Technischen Universität Dresden

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMO.17.02

doi: 10.3205/15dgnc079, urn:nbn:de:0183-15dgnc0794

Published: June 2, 2015

© 2015 Juratli et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To examine, through the utilization of a large, prospectively collected database, whether antiplatelet or anticoagulation medication use at onset of a traumatic brain injury (TBI) is associated with either brain contusion (BC) progression, certain intracranial hemorrhage patterns, or worse outcome.

Method: A prospective study of isolated TBI patients was completed at one institution between 2008 and 2012. We correlated antiplatelet or anticoagulation medication use at onset of TBI with initial BC volumes, BC progression in the first 24 hours, intracranial hemorrhage pattern in the CT scan, and modified Rankin Score (mRS) at discharge as well as after one year.

Results: Of 227 patients included in this analysis, 51 patients (22.4%) were taking antiplatelet or anticoagulation medications at TBI onset. Use of the antiplatelet or anticoagulation medications had significant association with an increased BC volume at presentation (p=0.008) but not with the contusion progression at 24 hours (p=0.48). TBI patients with prior antiplatelet or anticoagulation medications had significantly more frequent posttraumatic acute subdural hematoma (66.7% vs. 50.3%, p=0.04) and had a significantly worse outcome (mRS ≥4) at discharge (p=0.020) as well as at one-year follow-up (p=0.026). In multivariable analysis, patients with prior use of antiplatelet or anticoagulation medications had a hazard ratio of 3.2 for unfavorable outcome at discharge (p=0.002) and of 2.3 after one year (p=0.006).

Conclusions: Use of antiplatelet or anticoagulation medications at TBI onset is associated with increased BC volumes, more severe intracranial hematoma and worse clinical short- and long-term outcome. These findings suggest that attempts to reverse antiplatelet or anticoagulation medications after TBI are warranted.