The impact of preinjury antiplatelet and anticoagulant pharmacotherapy on outcomes in elderly patients with hemorrhagic brain injury

Fortuna, Gerald R.; Mueller, Eric W.; James, Laura E.; Shutter, Lori A.; Butler, Karyn L.

doi:10.1016/j.surg.2008.06.009

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Volume 144, Issue 4 , Pages 598-605, October 2008

The impact of preinjury antiplatelet and anticoagulant pharmacotherapy on outcomes in elderly patients with hemorrhagic brain injury

Gerald R. Fortuna, MD
- Department of Surgery, Division of Pharmacy Practice, The University Hospital, University of Cincinnati, Cincinnati, Ohio
Eric W. Mueller, PharmD
- Department of Pharmacy Services, University of Cincinnati, Cincinnati, Ohio
Laura E. James, MS
- Department of Surgery, Division of Pharmacy Practice, The University Hospital, University of Cincinnati, Cincinnati, Ohio
Lori A. Shutter, MD
- Departments of Neurosurgery and Neurology, University of Cincinnati, Cincinnati, Ohio
Karyn L. Butler, MD
- Department of Surgery, Division of Pharmacy Practice, The University Hospital, University of Cincinnati, Cincinnati, Ohio
- Division of Trauma/Critical Care, University of Cincinnati, Cincinnati, Ohio
- Reprint requests: Karyn L. Butler, MD, Surgical Critical Care, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102-5037.
- Affiliation at time of research.

Accepted 12 June 2008. published online 01 September 2008.

Background

More elderly trauma patients are identified with preinjury use of clopidogrel, aspirin, or warfarin (CAW). The purpose of this study was to determine whether preinjury CAW use was an important predictor of mortality in patients aged ≥50 years with blunt, hemorrhagic brain injury (HBI).

Methods

A retrospective review of patients with blunt, HBI aged ≥50 years with subgroup analysis for older (>70 years) and younger (50−70 years) patients was performed. CAW use was analyzed for differences in age, gender, hospital length of stay (LOS), Injury Severity Score (ISS), Glasgow Coma Score (GCS), mechanism of injury (MOI), platelet transfusion therapy (PLT), disposition at discharge, and in-hospital mortality.

Results

From January 2003 to October 2005, 416 patients were identified. The mean age was 69±1 years. No differences were found for ISS (24 ± 0.5), GCS (12 ± 0.2), or LOS (8 ± 0.4 days). CAW use was present in 40% of patients and significantly higher in older patients. Mortality was not different between older and younger CAW(+) patients, but it significantly increased for older CAW(−) patients. Significant predictors of death included age, ISS, and GCS (P<.02).

Conclusions

Preinjury CAW use in older blunt, HBI patients is not associated with increased mortality. Age was a significant predictor of mortality independent of CAW use.