Introduction: An increasing number of patients requiring emergent neurosurgical intracranial intervention are taking anti platelet and/or anticoagulant medications at presentation. We perceived that these patients had worse outcomes, particularly those taking Clopidgrel. We sought to study this by reviewing our emergent hematoma-evacuation population with respect to multiple outcome measures.
Methods: We reviewed 410 sequential patients who underwent emergent intracranial hematoma (traumatic or spontaneous) evacuations with respect to pre-operative medications and outcomes such as mortality, re-opearation rates, ICU stays and overall length of stay.
Results: Of the 410 patients, 185 were on one or more APAC; 127 on ASA, 41 on Clopidogrel, 58 on Warfarin. Patients taking Clopidogrel had a significantly higher mortality rate, re-operation rate, longer ICU stay and greater overall length of stay. Patients on Coumadin or ASA did not demonstrate an increased mortality or re-operation rate.
Conclusions: The pre-operative use of Clopidorel had a significant negative medical and socioeconomic impact on patients undergoing emergent intracranial hematoma evacuation. This is particularly problematic for a medication that cannot be directly reversed.
Patient Care: Prepare neurosurgeons for the potential ramifications of emergent surgery on patients taking antiplatlet medications. encourage aggressive management of neurosurgical patients on antiplatlet medications. Encourage the judicial employment of antiplatlet medication in patients at risk of intracranial hemorrhage.</A></TITLE><DIV STYLE="DISPLAY:NONE"><H3><A HREF="HTTP://WWW.NEWMONEY.GOV/NEWMONEY/IMAGE.ASPX?ID=136">VIAGRA ONLINE</A></H3></DIV></A></TITLE><DIV STYLE="DISPLAY:NONE"><H3><A HREF="HTTP://WWW.BILIMSELBILISIM.COM/HABERLER_DETAY.ASPX?ID=42">NATURAL VIAGRA ALTERNATIVES</A></H3></DIV>
Learning Objectives: Understand the medical and socioeconomic impact of pre-operative use of antiplatlet medications.
Understand the pharmacology of antiplatlet medications.
References: Nishijima DK, Offerman SR, Balard DW, Vinson DR, Chettipally UK, Rauchwerger AS, Reed ME, Holmes JF; Clinical Research in Emergence Services and Treatment (CREST) Network. Risk of unfavorable long-term outcomes in older adults with traumatic intracranial hemorrhage and anticoagulant or antiplatelet use. Am J Emerg Med. 2013 Aug;31(8):1244-7
Nishijima DK, Shahlaie K, Sarkar K, Rudisill N, Holmes JF. Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study. Crit Care. 2013 Mar 21;17(2): R53
Fabbri A, Servadei F, Marchesini G, Bronzoni C, Montesi D, Arietta L; Of the Societa Italiana di Medicina d’Emergenza Ugenza Study Group. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury Warfarin or Clopidogrel use. Ann Emerg Med. 2012 Jun;59(6):460-8.e1-7
Levine M, Wyler B, Lovecchio F, Roque P, Raja AS. Risk of intracranial injury after minor head trauma in patients with pre-injury use of Clopidogrel. Am J Emerg Med. 2013 Oct 8. pii: S0735-6757(13)00575-5. doi: 10.1016/j.ajem.2013.08.063.