• Eur J Trauma Emerg Surg · Dec 2022

    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, Lundager ForbergJakobJClinical Sciences, Lund University, Svartbrödragränden 3-5, 251 87, Helsingborg, Sweden., Ebba Anefjäll, Riikka Lehtinen, Mohammed Faisal, and Marcus Edelhamre.
    • Clinical Sciences, Lund University, Svartbrödragränden 3-5, 251 87, Helsingborg, Sweden. tomas.vedin@med.lu.se.
    • Eur J Trauma Emerg Surg. 2022 Dec 1; 48 (6): 490949174909-4917.

    BackgroundTraumatic 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.MethodsThis 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.ResultsThe 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).ConclusionThis 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.© 2022. The Author(s).

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