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Predictors of Mortality in Trauma Patients With Intracranial Hemorrhage on Preinjury Aspirin or Clopidogrel

Ivascu, Felicia A. MD; Howells, Greg A. MD; Junn, Fredrick S. MD; Bair, Holly A. MSN; Bendick, Phillip J. PhD; Janczyk, Randy J. MD

The Journal of Trauma: Injury, Infection, and Critical Care: October 2008 - Volume 65 - Issue 4 - p 785-788
doi: 10.1097/TA.0b013e3181848caa
Original Articles

Background: The mortality risk in elderly patients who sustained head trauma resulting in intracranial hemorrhage (ICH) while taking the antiplatelet agents aspirin (ASA) or clopidogrel or both (Plavix) was evaluated.

Methods: A retrospective review identified trauma patients, age 50 or greater, who had computed tomography (CT) evidence of ICH and were taking ASA, clopidogrel, or a combination of both. Patient demographics, type of medication, mechanism of injury, Glasgow Coma Score (GCS), grading of head CT scans, and outcomes were characterized.

Results: One hundred nine patients including 61 men and 48 women were identified; the mean age was 77 years ± 10 years. Injury was due to level fall (73), fall from height (21), motor vehicle crash (11), and other (4). Twenty (18%) patients died; age, gender, type of medication, and mechanism of injury were not predictive of death. The initial GCS for survivors was 14.2 ± 1.9 versus 11.3 ± 4.9 for nonsurvivors (p < 0.007). Deaths based on initial CT grade were: grade 1, 5 of 70; grade 2, 4 of 17; grade 3, 5 of 10; grade 4, 6 of 12 (p = 0.002). Follow-up CT scans were performed in 81 patients who were not taken to surgery and had grade 1 or 2 hemorrhage initially. Of 4 patients with hemorrhage progression, there was 1 death (25%) versus 6 deaths in 77 patients without progression (8%; p = 0.70).

Conclusions: There is high mortality rate associated with ASA or clopidogrel or both in elderly patients who have head trauma resulting in ICH. The presenting GCS and initial grade of CT scan are most predictive of death. Progression of hemorrhage after admission is unusual. The risk of brain injury, particularly from falls, should be explained to elderly patients taking these medications.

From the William Beaumont Hospital, Royal Oak, Michigan.

Submitted for publication September 18, 2005.

Accepted for publication June 24, 2008.

Presented at the 18th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 12–15, 2005, Ft. Lauderdale, Florida.

Address for reprints: Dr. Felicia Ivascu, MD, 3601 W 13 Mile, Royal Oak, MI 48307; email:

© 2008 Lippincott Williams & Wilkins, Inc.