• Kiarash Shahlaie, Daniel K Nishijima, James F Holmes, Korak Sarkar, and Nancy Rudisill.
• Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA. daniel.nishijima@ucdmc.ucdavis.edu
• Am J Emerg Med. 2013 Aug 1;31(8):1244-7.

Study ObjectiveThe objective was to compare neurological outcomes at 6 months in older patients with preinjury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage with those without prior use of these medications.MethodsThis was a retrospective study conducted at a Level 1 trauma center from April 2009 to July 2010. Patients older than 55 years with isolated mild head injury (Glasgow Coma Scale score 13-15 and Abbreviated Injury Score < 3 in nonhead body region) were included. Demographic, clinical, and outcome data were abstracted from an existing traumatic brain injury database. The primary end point of unfavorable extended Glasgow Outcome Score at 6 months was compared between patients with and without preinjury warfarin or clopidogrel use.ResultsSeventy-seven eligible patients were identified: 27 (35%) with preinjury warfarin or clopidogrel use and 50 (65%) without. Baseline characteristics (sex, Glasgow Coma Scale score, Injury Severity Score, computed tomography score, and in-hospital mortality) were similar between cohorts, although the preinjury warfarin or clopidogrel cohort was older than the control group (P < .05). Patients in the preinjury warfarin or clopidogrel cohort were more likely to have an unfavorable outcome (16/27; 59.3%; 95% confidence interval, 40.7%-77.8%) as compared with those without (18/50; 36.0%; 95% confidence interval, 22.7%-49.3%) (P = .05).ConclusionOlder adults with preinjury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage may be at an increased risk for unfavorable long-term neurological outcomes compared with similar patients without preinjury use of these medications.Copyright © 2013 Elsevier Inc. All rights reserved.

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