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Glasgow coma scale and other factors can predict normal brain imaging scans after traumatic brain injury in patients who take antiplatelet drugs

An estimated one million people sustain a traumatic brain injury (TBI) in the United States every year. TBI is a leading cause of morbidity and mortality across all age groups – and increasingly in elderly people, who represent 25% of trauma-related deaths. People over 65 years old may be at particularly high risk for TBI-related death and disability because this population is more likely to take antiplatelet drugs. Antiplatelet drugs limit blood clotting in the bloodstream, reducing the risk of stroke and heart attack in older patients. Unfortunately, research suggests that the anti-clotting effects of antiplatelet medications may increase the risk of hemorrhage after TBI.

A team of researchers in France investigated the best clinical methods for identifying the risk of brain hemorrhage in TBI patients who take antiplatelet drugs. Currently, computed tomography (CT) scans, a type of brain imaging, is the gold standard in French hospitals for identifying brain lesions. However, the researchers aimed to discover other predictors of hemorrhage that could reduce the number of unnecessary CT scans, most of which have normal results. The researchers performed CT scans on 293 TBI patients who take antiplatelet drugs, and they found that about nine percent of patients exhibited intracranial bleeding as a result of their injuries. These participants were more likely to:

  • Have a history of severe hemorrhage;
  • Experience headache or vomiting after injury;
  • Score abnormally on the Glasgow coma scale, a measure of TBI severity; and
  • Take antiplatelet drugs.

Although CT scans are a valuable tool for assessing brain lesions and bleedings after TBI, clinicians may be able to reduce the number of unnecessary CT scans by using predictive factors to determine which patients are at highest risk for injury-related brain hemorrhage. Importantly, the use of antiplatelet medications may put elderly populations at increased risk for brain bleeds after TBI.

Moustafa F, Roubin J, Pereira B, et al. Predictive factors of intracranial bleeding in head trauma patients receiving antiplatelet therapy admitted to an emergency department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. (June 2018).


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