Background: This study was designed to determine whether or not older trauma patients on clopidogrel have an increased risk of morbidity and mortality.
Methods: A retrospective review was performed on all trauma patients > or =50 years of age between January 1, 2002, and August 31, 2005. The charts of those patients who had documented preinjury use of clopidogrel were further reviewed. A control group of patients with no history of clopidogrel use was matched for age, sex, mechanism of injury, and injury severity score.
Results: During this time period, there were 1,020 trauma patients > or =50 years of age admitted, 43 of which had documented preinjury clopidogrel use (P). A higher percentage of patients in the P group underwent cranial surgery, had episodes of rebleeds, and required transfusions of blood products than in the control group. The mortality and length of stay were comparable in both groups.
Conclusion: This study indicates that the preinjury use of clopidogrel may cause significant morbidity in patients with closed-head injuries. Further studies are needed to suggest specific treatment modalities.
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http://dx.doi.org/10.1016/j.amjsurg.2006.08.037 | DOI Listing |
J Trauma Acute Care Surg
January 2025
From the Spencer Fox Eccles School of Medicine (D.G., J.A.), Department of Neurosurgery (D.B., M.T.B., S.T.M., R.G.), Department of Surgery (S.L., J.C., M.M., T.E.), Division of Geriatrics and Department of Internal Medicine (M.P.), University of Utah, Salt Lake City, Utah; and Bowers Neurosurgical Frailty and Outcomes Data Science Lab (C.A.B.), Flint, Michigan.
Background: Preinjury antithrombotic (AT) use is associated with worse outcomes for geriatric (65 years or older) patients with traumatic brain injury (TBI). Previous studies have found that use of AT outside established guidelines is widespread in TBI patients.
Methods: In this single-center retrospective cross-sectional study, we examined inappropriate AT use among geriatric patients presenting with traumatic intracranial hemorrhage.
Neurosurgery
November 2023
Harvard Medical School, Boston , Massachusetts , USA.
Background And Objectives: A growing proportion of the US population is on antithrombotic therapy (AT), most significantly within the older subpopulation. Decision to use AT is a balance between the intended benefits and known bleeding risk, especially after traumatic brain injury (TBI). Preinjury inappropriate AT offers no benefit for the patient and also increases the risk of intracranial hemorrhage and worse outcome in the setting of TBI.
View Article and Find Full Text PDFEmerg Med J
March 2023
Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Background: Several current guidelines do not include antiplatelet use as an explicit indication for CT scan of the head following head injury. The impact of individual antiplatelet agent use on rates of intracranial haemorrhage is unclear. The primary objective of this systematic review was to assess if clopidogrel monotherapy was associated with traumatic intracranial haemorrhage (tICH) on CT of the head within 24 hours of presentation following head trauma compared with no antithrombotic controls.
View Article and Find Full Text PDFAm J Surg
December 2022
HonorHealth John C, Lincoln Hospital, United States.
Background: Fascia iliaca compartment block (FICB) is an effective method to treat pain in adult trauma patients with hip fracture. Of importance is the high prevalence of preinjury anticoagulants and antiplatelet medications in this population. To date, we have not identified any literature that has specifically evaluated the safety of FICB with continuous catheter infusion in patients on antiplatelet and/or anticoagulant therapy.
View Article and Find Full Text PDFNeurotrauma Rep
August 2022
Interdepartmental Division of Critical Care Medicine, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
There is an increasing number of trauma patients presenting on pre-injury antiplatelet (AP) agents attributable to an aging population and expanding cardio- or cerebrovascular indications for antithrombotic therapy. The effects of different AP regimens on outcomes after traumatic brain injury (TBI) have yet to be elucidated, despite the implications on patient/family counseling and the potential need for better reversal strategies. The goal of this systematic review and meta-analysis was to assess the impact of different pre-injury AP regimens on outcomes after TBI.
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