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. 2022 Dec;48(6):4909-4917.
doi: 10.1007/s00068-022-02016-8. Epub 2022 Jun 22.

Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study

Tomas Vedin  1 , Jakob Lundager Forberg  2 , Ebba Anefjäll  2 , Riikka Lehtinen  2 , Mohammed Faisal  3 , Marcus Edelhamre  2
Affiliations

Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study

Tomas Vedin et al. Eur J Trauma Emerg Surg. 2022 Dec.

Abstract

Background: Traumatic brain injury (TBI) is a common injury and constitutes up to 3% of emergency department (ED) visits. Current studies show that TBI is most commonly inflicted in older patients after ground-level falls. These patients often take medications affecting coagulation such as anticoagulants or antiplatelet drugs. Guidelines for ED TBI-management assume that anticoagulation therapy (ACT) confers a higher risk of traumatic intracranial hemorrhage (TICH) than antiplatelet therapy (APT). However, recent studies have challenged this. This study aimed to evaluate if oral anticoagulation and platelet inhibitors affected rate of TICH in head-trauma patients with ground-level falls.

Methods: This was a retrospective review of medical records during January 1, 2017 to December 31, 2017 and January 1 2020 to December 31, 2020 of all patients seeking ED care because of head-trauma. Patients ≥ 18 years with ground-level falls were included.

Results: The study included 1938 head-trauma patients with ground-level falls. Median age of patients with TICH was 81 years. The RR for TICH in APT-patients compared to patients without medication affecting coagulation was 1.72 (p = 0.01) (95% Confidence Interval (CI) 1.13-2.60) and 1.08 (p = 0.73), (95% CI 0.70-1.67) in ACT-patients. APT was independently associated with TICH in regression analysis (OR 1.59 (95% CI 1.02-2.49), p = 0.041).

Conclusion: This study adds to the growing evidence that APT-patients with ground-level falls might have as high or higher risk of TICH than ACT-patients. This is not addressed in the current guidelines which may need to be updated. We therefore recommend broad prospective studies.

Keywords: (MESH); Anticoagulants; Brain injuries; Intracranial hemorrhages; Tomography; Traumatic; X-ray computed.

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Conflict of interest statement

Authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Inclusion process of the entire study with 988 included patients from 2017 and 950 included patients from 2020, all with ground-level falls
See this image and copyright information in PMC

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