Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study

Introduction: Pre-injury antithrombotic therapy might influence the outcome of subjects with head injuries and
positive computed tomography (CT) scans. We aimed to determine the potential risk of pre-injury antiplatelet drug
use on short- and long-term outcome of head injured subjects admitted to emergency departments (EDs) in Italy
for extended observation.
Methods: A total of 1,558 adult subjects with mild, moderate and severe head injury admitted to Italian EDs were
studied. In multivariable logistic regression analyses, the short-term outcome was assessed by an evaluation of
head CT scan at 6 to 24 hours after trauma and the long-term outcome by the Glasgow outcome scale (GOS) at
six months.
Results: Head CT scan comparisons showed that 201 subjects (12.9%) worsened. The risk of worsening was
increased two fold by the use of antiplatelet drugs (106, 19.7% treated versus 95, 9.3% untreated; relative risk (RR)
2.09, 95% CI 1.63 to 2.71). The risk was particularly high in subjects on clopidogrel (RR 5.76, 95% CI 3.88 to 8.54),
independent of the association with aspirin. By logistic regression, 5 of 14 items were independently associated
with worsening (Glasgow coma scale (GCS), Marshall category, antiplatelet therapy, intraventricular hemorrhage,
number of lesions). After six months, only 4 of 14 items were predictors of unfavorable outcome (GOS 1 to 3) (GCS
score, Marshall category, age in decades, intracerebral hemorrhage/contusion). The risk increased by 50% in the
group treated with antiplatelet therapy (RR 1.58, 95% CI 1.28 to 1.95; P < 0.001).
Conclusions: Antithrombotic therapy (in particular clopidogrel) is a risk factor for both short-term and long-term
unfavorable outcome in subjects with head injury, increasing the risk of progression and death, permanent
vegetative state and severe disability.