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Journal article
Increased relative risk of delayed hemorrhage in patients taking anticoagulant/antiplatelet medications with concurrent aspirin therapy: implications for clinical practice based on 3-year retrospective analysis in a large health system
Emergency radiology, v 29(2), pp 353-358
01 Apr 2022
PMID: 34988752
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose The incidence of delayed posttraumatic intracranial hemorrhage (DH) in patients on anticoagulant (AC) and antiplatelet (AP) medications, especially with concurrent aspirin therapy, is not well established, with studies reporting disparate results with between 1-10% risk of DH and 0-3% mortality. The purpose of this 3-year retrospective study is to evaluate the true risk of DH in patients on AP/AC medications with or without concurrent aspirin therapy. Methods One thousand forty-six patients taking AP and AC medications presenting to network emergency departments with head trauma who had repeat CT to evaluate for DH were included in the study. Repeat examinations were typically performed within 24 h (average follow-up time was 21 h and 99% were within 3 days). Mean time to DH was 20 h. All positive studies were reviewed by two board-certified neuroradiologists. Patients were excluded from the study if hemorrhage was retrospectively identified on the initial examination. Cases were reclassified as negative if hemorrhage on the follow-up examination was thought to be not present or artifactual. Cases were considered positive if the initial examination was negative and the follow-up examination demonstrated new hemorrhage. Results Overall, there was 1.91% incidence (20 patients) of DH and 0.3% overall mortality (3 patients). The group of patients taking warfarin or AP agents demonstrated a significantly higher rate of DH (3.2% compared to 0.9%) and higher mortality (0.9% compared to 0.0%) compared to the DOAC group (p < 0.01). The risk of DH in patients taking AC or AP agents with aspirin (13/20 cases) was significantly higher (RR 3.8, p < 0.01) than that of patients taking AC or AP alone (7/20 cases). Conclusion The risk of DH was significantly higher in patients taking aspirin in addition to AC/AP medications. Repeat imaging should be obtained for trauma patients taking AC/AP agents with concurrent aspirin. The rate of DH was also significantly higher in patients taking warfarin or AP agents when compared to patients taking DOACs. Repeat examination should be strongly considered on patients taking warfarin or AP agents without aspirin. Given the relatively low risk of DH in patients taking DOACs alone, repeat imaging could be reserved for patients with external signs of trauma or dangerous mechanism of injury.
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Details
- Title
- Increased relative risk of delayed hemorrhage in patients taking anticoagulant/antiplatelet medications with concurrent aspirin therapy: implications for clinical practice based on 3-year retrospective analysis in a large health system
- Creators
- Warren Chang - Allegheny Health NetworkDanielle Yin - Allegheny Health NetworkCharles Li - Allegheny Health NetworkBrian Weston - Allegheny Health NetworkAlbert Sohn - Allegheny Health NetworkChristian Wanamaker - Allegheny Health NetworkMatthew Kulzer - Allegheny Health NetworkTyson Tragon - Allegheny Health NetworkMichael Spearman - Allegheny Health NetworkLaura Eisenmenger - University of Wisconsin–MadisonMichael Goldberg - Allegheny Health Network
- Publication Details
- Emergency radiology, v 29(2), pp 353-358
- Publisher
- Springer Nature
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiology (Radiologic Sciences)
- Web of Science ID
- WOS:000739246500001
- Scopus ID
- 2-s2.0-85122301896
- Other Identifier
- 991021897486704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Radiology, Nuclear Medicine & Medical Imaging