Elisa M Fiorelli1, Viviana Bozzano1, Mattia Bonzi2, Silvia V Rossi2, Giorgio Colombo1, Gaia Radici2, Tiberio Canini3, Hayato Kurihara4, Giovanni Casazza5, Monica Solbiati6, Giorgio Costantino6. 1. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Medicina Generale-Immunologia e Allergologia, Milano, Italy. 2. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina d'Urgenza, Milano, Italy. 3. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, UOSD Chirurgia d'Urgenza, Milano, Italy. 4. IRCCS Humanitas Research Hospital, UOC Chirurgia Generale, Chirurgia d'Urgenza e del Trauma, Rozzano Milano, Italy. 5. Dipartimento di Scienze Biomediche e Cliniche "L. Sacco," Università a degli Studi di Milano, Milano, Italy. 6. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina d'Urgenza, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy.
Abstract
BACKGROUND: Mild traumatic brain injury (TBI) is a common event and antiplatelet therapy might represent a risk factor for bleeding. OBJECTIVE: The aim of this study was to evaluate the risk of intracranial hemorrhage (ICH) after mild TBI in patients on antiplatelet therapy through a systematic review and meta-analysis. METHODS: We conducted a systematic review and meta-analysis of prospective and retrospective observational studies on patients with mild TBI on antiplatelet therapy vs. those not on any antithrombotic therapy. The primary outcome was the risk of ICH in patients with mild TBI based on the first computed tomography scan. Secondary outcome was the risk of mortality and neurosurgery. RESULTS: Nine studies and 14,545 patients were included. The incidence of ICH ranged from 3.6% to 29.4% in the antiplatelet group and from 1.6% to 21.1% in the control group. Patients on antiplatelet therapy had a higher risk of ICH after a mild TBI compared with patients that were not on antithrombotic therapy (risk ratio 1.51; 95% confidence interval 1.21-1.88). No difference was found in the composite outcome of mortality and neurosurgery. CONCLUSIONS: Patients on antiplatelet therapy have an increased risk of ICH after mild TBI compared with patients not on antithrombotic therapy. However, the risk is just slightly increased, and the need to perform a computed tomography scan in patients on antiplatelet therapy after a mild TBI should be evaluated case by case, but always considered in patients with other risk factors.
BACKGROUND: Mild traumatic brain injury (TBI) is a common event and antiplatelet therapy might represent a risk factor for bleeding. OBJECTIVE: The aim of this study was to evaluate the risk of intracranial hemorrhage (ICH) after mild TBI in patients on antiplatelet therapy through a systematic review and meta-analysis. METHODS: We conducted a systematic review and meta-analysis of prospective and retrospective observational studies on patients with mild TBI on antiplatelet therapy vs. those not on any antithrombotic therapy. The primary outcome was the risk of ICH in patients with mild TBI based on the first computed tomography scan. Secondary outcome was the risk of mortality and neurosurgery. RESULTS: Nine studies and 14,545 patients were included. The incidence of ICH ranged from 3.6% to 29.4% in the antiplatelet group and from 1.6% to 21.1% in the control group. Patients on antiplatelet therapy had a higher risk of ICH after a mild TBI compared with patients that were not on antithrombotic therapy (risk ratio 1.51; 95% confidence interval 1.21-1.88). No difference was found in the composite outcome of mortality and neurosurgery. CONCLUSIONS:Patients on antiplatelet therapy have an increased risk of ICH after mild TBI compared with patients not on antithrombotic therapy. However, the risk is just slightly increased, and the need to perform a computed tomography scan in patients on antiplatelet therapy after a mild TBI should be evaluated case by case, but always considered in patients with other risk factors.
Authors: Giuseppe Maria Della Pepa; Marcello Covino; Grazia Menna; Anna Maria Auricchio; Filippo Maria Polli; Alberto Manno; Benedetta Simeoni; Alessandro Olivi; Francesco Franceschi Journal: Acta Neurochir (Wien) Date: 2021-11-30 Impact factor: 2.216