Title: What is the Risk of Traumatic Intracranial Injury with Antiplatelet and Anticoagulant Use?<br/>Author: WanTsu Wendy Chang<br/><a href='http://umem.org/profiles/faculty/1322/'>[Click to email author]</a><hr/><ul>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Current ACEP guidelines recommend to consider neuroimaging after blunt head trauma in patients with coagulopathy.</span></span></span></span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">However, they do not provide guidance specific to antiplatelet vs. anticoagulant medications.</span></span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">A recent multicenter prospective observational study of 9070 patients where 14.6% were receiving antiplatelet medications or warfarin found the relative risk of significant intracranial injury was:</span></span>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">1.29 (95% CI 0.88-1.87) for aspirin alone</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">0.75 (95% CI 0.24-2.30) for clopidogrel alone</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">1.88 (95% CI 1.28-2.75) for warfarin alone</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">2.88 (95% CI 1.53-5.42) for aspirin and clopidogrel in combination</span></span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Significant intracranial injury did not include isolated linear or basilar skull fractures or single small cerebral contusions <2 cm in diameter.</span></span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">The study only included patients who underwent neuroimaging, though the researchers also looked at 368 consecutive patients with blunt head injury who did not receive neuroimaging and did not find any missed injuries at 3-month follow-up.</span></span></li>
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        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><u>Bottom Line</u>:</strong> Patients on warfarin or a combination of aspirin and clopidogrel have increased risk of significant intracranial injury after blunt head trauma.  Aspirin or clopidogrel monotherapy do not appear to be risk factors.</span></span></p>
<fieldset><legend>References</legend>

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                <span style="font-size: 14px;"><span style="font-family: arial, helvetica, sans-serif;"><span style="font-size: 14px;"><span style="font-family: arial, helvetica, sans-serif;">ACEP clinical policy: Neuroimaging and decision making in adult mild traumatic brain injury in the acute setting. <i>Ann Emerg Med. </i>2008;52:714-748.</span></span></span></span></li>
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                <span style="font-size: 14px;"><span style="font-family: arial, helvetica, sans-serif;">Probst MA, Gupta M, Handey GW, <i>et al</i>. Prevalence of intracranial injury in adult patients with blunt head trauma with and without anticoagulant or antiplatelet use. <i>Ann Emerg Med</i>. 2020;75(3):354-364.</span></span></li>
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