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Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study
INTRODUCTION: Pre-injury antithrombotic therapy might influence the outcome of subjects with head injuries and positive computed tomography (CT) scans. We aimed to determine the potential risk of pre-injury antiplatelet drug use on short- and long-term outcome of head injured subjects admitted to em...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733424/ https://www.ncbi.nlm.nih.gov/pubmed/23514619 http://dx.doi.org/10.1186/cc12575 |
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author | Fabbri, Andrea Servadei, Franco Marchesini, Giulio Bronzoni, Carolina Montesi, Danilo Arietta, Luca |
author_facet | Fabbri, Andrea Servadei, Franco Marchesini, Giulio Bronzoni, Carolina Montesi, Danilo Arietta, Luca |
author_sort | Fabbri, Andrea |
collection | PubMed |
description | INTRODUCTION: Pre-injury antithrombotic therapy might influence the outcome of subjects with head injuries and positive computed tomography (CT) scans. We aimed to determine the potential risk of pre-injury antiplatelet drug use on short- and long-term outcome of head injured subjects admitted to emergency departments (EDs) in Italy for extended observation. METHODS: A total of 1,558 adult subjects with mild, moderate and severe head injury admitted to Italian EDs were studied. In multivariable logistic regression analyses, the short-term outcome was assessed by an evaluation of head CT scan at 6 to 24 hours after trauma and the long-term outcome by the Glasgow outcome scale (GOS) at six months. RESULTS: Head CT scan comparisons showed that 201 subjects (12.9%) worsened. The risk of worsening was increased two fold by the use of antiplatelet drugs (106, 19.7% treated versus 95, 9.3% untreated; relative risk (RR) 2.09, 95% CI 1.63 to 2.71). The risk was particularly high in subjects on clopidogrel (RR 5.76, 95% CI 3.88 to 8.54), independent of the association with aspirin. By logistic regression, 5 of 14 items were independently associated with worsening (Glasgow coma scale (GCS), Marshall category, antiplatelet therapy, intraventricular hemorrhage, number of lesions). After six months, only 4 of 14 items were predictors of unfavorable outcome (GOS 1 to 3) (GCS score, Marshall category, age in decades, intracerebral hemorrhage/contusion). The risk increased by 50% in the group treated with antiplatelet therapy (RR 1.58, 95% CI 1.28 to 1.95; P < 0.001). CONCLUSIONS: Antithrombotic therapy (in particular clopidogrel) is a risk factor for both short-term and long-term unfavorable outcome in subjects with head injury, increasing the risk of progression and death, permanent vegetative state and severe disability. |
format | Online Article Text |
id | pubmed-3733424 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-37334242013-08-05 Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study Fabbri, Andrea Servadei, Franco Marchesini, Giulio Bronzoni, Carolina Montesi, Danilo Arietta, Luca Crit Care Research INTRODUCTION: Pre-injury antithrombotic therapy might influence the outcome of subjects with head injuries and positive computed tomography (CT) scans. We aimed to determine the potential risk of pre-injury antiplatelet drug use on short- and long-term outcome of head injured subjects admitted to emergency departments (EDs) in Italy for extended observation. METHODS: A total of 1,558 adult subjects with mild, moderate and severe head injury admitted to Italian EDs were studied. In multivariable logistic regression analyses, the short-term outcome was assessed by an evaluation of head CT scan at 6 to 24 hours after trauma and the long-term outcome by the Glasgow outcome scale (GOS) at six months. RESULTS: Head CT scan comparisons showed that 201 subjects (12.9%) worsened. The risk of worsening was increased two fold by the use of antiplatelet drugs (106, 19.7% treated versus 95, 9.3% untreated; relative risk (RR) 2.09, 95% CI 1.63 to 2.71). The risk was particularly high in subjects on clopidogrel (RR 5.76, 95% CI 3.88 to 8.54), independent of the association with aspirin. By logistic regression, 5 of 14 items were independently associated with worsening (Glasgow coma scale (GCS), Marshall category, antiplatelet therapy, intraventricular hemorrhage, number of lesions). After six months, only 4 of 14 items were predictors of unfavorable outcome (GOS 1 to 3) (GCS score, Marshall category, age in decades, intracerebral hemorrhage/contusion). The risk increased by 50% in the group treated with antiplatelet therapy (RR 1.58, 95% CI 1.28 to 1.95; P < 0.001). CONCLUSIONS: Antithrombotic therapy (in particular clopidogrel) is a risk factor for both short-term and long-term unfavorable outcome in subjects with head injury, increasing the risk of progression and death, permanent vegetative state and severe disability. BioMed Central 2013 2013-03-21 /pmc/articles/PMC3733424/ /pubmed/23514619 http://dx.doi.org/10.1186/cc12575 Text en Copyright © 2013 Fabbri et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Fabbri, Andrea Servadei, Franco Marchesini, Giulio Bronzoni, Carolina Montesi, Danilo Arietta, Luca Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study |
title | Antiplatelet therapy and the outcome of subjects with intracranial injury: the
Italian SIMEU study |
title_full | Antiplatelet therapy and the outcome of subjects with intracranial injury: the
Italian SIMEU study |
title_fullStr | Antiplatelet therapy and the outcome of subjects with intracranial injury: the
Italian SIMEU study |
title_full_unstemmed | Antiplatelet therapy and the outcome of subjects with intracranial injury: the
Italian SIMEU study |
title_short | Antiplatelet therapy and the outcome of subjects with intracranial injury: the
Italian SIMEU study |
title_sort | antiplatelet therapy and the outcome of subjects with intracranial injury: the
italian simeu study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733424/ https://www.ncbi.nlm.nih.gov/pubmed/23514619 http://dx.doi.org/10.1186/cc12575 |
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