Ann Emerg Med

Objective:To determine the prevalence of significant intracranial injury among adults with blunt head trauma who are on preinjury anticoagulant or antiplatelet medications.Methods:This was a multicenter, prospective, observational, study conducted from December 2007 to December 2015. Patients were enrolled in three emergency departments in the United States. Adults with blunt head trauma who underwent neuroimaging in the emergency department were included. Use of preinjury aspirin, clopidogrel, warfarin was recorded. Data on direct oral anticoagulants was not specifically recorded. The primary outcome was prevalence of significant intracranial injury on neuroimaging. The secondary outcome was receipt of neurosurgical intervention.Results:Among 9,070 patients enrolled in this study, the median age was 53.8 years (IQR: 34.7 to 74.3) and 60.7% were male. A total of 1,323 patients (14.6%) were taking antiplatelet medications or warfarin, including 635 taking aspirin alone, 109 clopidogrel alone, and 406 warfarin alone. As compared to patients without any coagulopathy, the relative risk of significant intracranial injury was 1.29 (95% CI: 0.88, 1.87) for patients taking aspirin alone, 0.75 (95% CI: 0.24, 2.30) for those taking clopidogrel alone, and 1.88 (95% CI: 1.28, 2.75) taking warfarin alone. The relative risk of significant intracranial injury was 2.88 (95% CI: 1.53, 5.42) for patients taking aspirin and clopidogrel in combination.Conclusions:Patients on preinjury warfarin or a combination of aspirin and clopidogrel were at increased risk for significant intracranial injury, but not those on aspirin alone. Clinicians should have a low threshold for neuroimaging when evaluating patients on warfarin or on a combination of aspirin and clopidogrel.F32 HL120466/HL/NHLBI NIH HHS/United StatesK23 HL132052/HL/NHLBI NIH HHS/United StatesR01 CE001589/CE/NCIPC CDC HHS/United StatesR01 HS009699/HS/AHRQ HHS/United States2021-03-01T00:00:00Z31959538PMC70397667273vault:3469