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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...

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Autores principales: Fabbri, Andrea, Servadei, Franco, Marchesini, Giulio, Bronzoni, Carolina, Montesi, Danilo, Arietta, Luca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
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.
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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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