Antiplatelet Agents Tied to Risk of Brain Hemorrhage

Major Finding: Traumatic intracranial hemorrhage was seen in 6.2% of all trauma admissions in 1999–2000 and in 12.3% in 2007-2008, while the use of strong antiplatelet agents increased fivefold.

Data Source: Review of the hospital records for 526 patients admitted with intracranial hemorrhage.

Disclosures: Dr. Siracuse reported no relevant financial interests. The study was sponsored by Beth Israel Deaconess Medical Center, and the principal investigator was Dr. Carl J. Hauser.

CHICAGO — Increasing rates of traumatic intracranial hemorrhage in elderly patients appeared to be related to the use of antiplatelet agents in a retrospective study.

The rise in traumatic intracranial hemorrhage (TICH) occurred without significant increases in diagnosis of atrial fibrillation or in use of warfarin (Coumadin), and overall mortality did not change, Dr. Jeffrey J. Siracuse said at the annual meeting of the Central Surgical Association.

“Patients with atrial fibrillation are at high risk for stroke and may also be at high risk for bleeding complications,” said Dr. Siracuse of Beth Israel Deaconess Medical Center, Boston. These patients often are treated with anticoagulants based on their estimated risk of thromboembolism, and are likely to be taking antiplatelet agents.

The review of the hospital's trauma registry database of 5,371 patients examined records for all 526 admitted with intracranial hemorrhage during 1999–2000 (139 patients) and 2007–2008 (387 patients). Intracranial hemorrhages were considered traumatic if they were secondary to an identified external injury.

The principal cause of trauma in both groups was a simple fall from the standing position. In the 1999–2000 group, 6.2% of all trauma admissions were TICH patients; this doubled to 12.3% in the 2007–2008 group.

The study found little increase in warfarin use in either group. But the use of “strong antiplatelet agents, specifically clopidogrel and Aggrenox, increased fivefold between the two periods,” Dr. Siracuse said. In the earlier period, 27% of TICH patients were on aspirin, but by the later period, 48% were on aspirin.

Overall, the mortality of patients with TICH was unchanged between the two periods (12.4% vs. 12.2%), and there was no difference in the mean number of hospital- and ICU-free days.

“We did not see a large increase, as we thought we would, in atrial fibrillation or in Coumadin use in our TICH population. This could perhaps reflect [the fact] that Massachusetts has the highest patient/physician primary care patient ratio in the country,” Dr. Siracuse said. This suggests that medical conditions were identified early and treated aggressively.

The vast majority of patients were injured by simple falls from standing, he said, and many patients on anticoagulation because of high risk for thromboembolism were also at high risk for falls. Increasing rates of TICH appeared to be associated with the use of strong antiplatelet agents rather than with increased warfarin use, he concluded.

Major Finding: Traumatic intracranial hemorrhage was seen in 6.2% of all trauma admissions in 1999–2000 and in 12.3% in 2007-2008, while the use of strong antiplatelet agents increased fivefold.

Data Source: Review of the hospital records for 526 patients admitted with intracranial hemorrhage.

Disclosures: Dr. Siracuse reported no relevant financial interests. The study was sponsored by Beth Israel Deaconess Medical Center, and the principal investigator was Dr. Carl J. Hauser.

CHICAGO — Increasing rates of traumatic intracranial hemorrhage in elderly patients appeared to be related to the use of antiplatelet agents in a retrospective study.

The rise in traumatic intracranial hemorrhage (TICH) occurred without significant increases in diagnosis of atrial fibrillation or in use of warfarin (Coumadin), and overall mortality did not change, Dr. Jeffrey J. Siracuse said at the annual meeting of the Central Surgical Association.

“Patients with atrial fibrillation are at high risk for stroke and may also be at high risk for bleeding complications,” said Dr. Siracuse of Beth Israel Deaconess Medical Center, Boston. These patients often are treated with anticoagulants based on their estimated risk of thromboembolism, and are likely to be taking antiplatelet agents.

The review of the hospital's trauma registry database of 5,371 patients examined records for all 526 admitted with intracranial hemorrhage during 1999–2000 (139 patients) and 2007–2008 (387 patients). Intracranial hemorrhages were considered traumatic if they were secondary to an identified external injury.

The principal cause of trauma in both groups was a simple fall from the standing position. In the 1999–2000 group, 6.2% of all trauma admissions were TICH patients; this doubled to 12.3% in the 2007–2008 group.

The study found little increase in warfarin use in either group. But the use of “strong antiplatelet agents, specifically clopidogrel and Aggrenox, increased fivefold between the two periods,” Dr. Siracuse said. In the earlier period, 27% of TICH patients were on aspirin, but by the later period, 48% were on aspirin.

Overall, the mortality of patients with TICH was unchanged between the two periods (12.4% vs. 12.2%), and there was no difference in the mean number of hospital- and ICU-free days.

“We did not see a large increase, as we thought we would, in atrial fibrillation or in Coumadin use in our TICH population. This could perhaps reflect [the fact] that Massachusetts has the highest patient/physician primary care patient ratio in the country,” Dr. Siracuse said. This suggests that medical conditions were identified early and treated aggressively.

The vast majority of patients were injured by simple falls from standing, he said, and many patients on anticoagulation because of high risk for thromboembolism were also at high risk for falls. Increasing rates of TICH appeared to be associated with the use of strong antiplatelet agents rather than with increased warfarin use, he concluded.

Major Finding: Traumatic intracranial hemorrhage was seen in 6.2% of all trauma admissions in 1999–2000 and in 12.3% in 2007-2008, while the use of strong antiplatelet agents increased fivefold.

Data Source: Review of the hospital records for 526 patients admitted with intracranial hemorrhage.

Disclosures: Dr. Siracuse reported no relevant financial interests. The study was sponsored by Beth Israel Deaconess Medical Center, and the principal investigator was Dr. Carl J. Hauser.

CHICAGO — Increasing rates of traumatic intracranial hemorrhage in elderly patients appeared to be related to the use of antiplatelet agents in a retrospective study.

The rise in traumatic intracranial hemorrhage (TICH) occurred without significant increases in diagnosis of atrial fibrillation or in use of warfarin (Coumadin), and overall mortality did not change, Dr. Jeffrey J. Siracuse said at the annual meeting of the Central Surgical Association.

“Patients with atrial fibrillation are at high risk for stroke and may also be at high risk for bleeding complications,” said Dr. Siracuse of Beth Israel Deaconess Medical Center, Boston. These patients often are treated with anticoagulants based on their estimated risk of thromboembolism, and are likely to be taking antiplatelet agents.

The review of the hospital's trauma registry database of 5,371 patients examined records for all 526 admitted with intracranial hemorrhage during 1999–2000 (139 patients) and 2007–2008 (387 patients). Intracranial hemorrhages were considered traumatic if they were secondary to an identified external injury.

The principal cause of trauma in both groups was a simple fall from the standing position. In the 1999–2000 group, 6.2% of all trauma admissions were TICH patients; this doubled to 12.3% in the 2007–2008 group.

The study found little increase in warfarin use in either group. But the use of “strong antiplatelet agents, specifically clopidogrel and Aggrenox, increased fivefold between the two periods,” Dr. Siracuse said. In the earlier period, 27% of TICH patients were on aspirin, but by the later period, 48% were on aspirin.

Overall, the mortality of patients with TICH was unchanged between the two periods (12.4% vs. 12.2%), and there was no difference in the mean number of hospital- and ICU-free days.

“We did not see a large increase, as we thought we would, in atrial fibrillation or in Coumadin use in our TICH population. This could perhaps reflect [the fact] that Massachusetts has the highest patient/physician primary care patient ratio in the country,” Dr. Siracuse said. This suggests that medical conditions were identified early and treated aggressively.

The vast majority of patients were injured by simple falls from standing, he said, and many patients on anticoagulation because of high risk for thromboembolism were also at high risk for falls. Increasing rates of TICH appeared to be associated with the use of strong antiplatelet agents rather than with increased warfarin use, he concluded.