PMID- 34988752 OWN - NLM STAT- MEDLINE DCOM- 20220315 LR - 20230402 IS - 1438-1435 (Electronic) IS - 1070-3004 (Print) IS - 1070-3004 (Linking) VI - 29 IP - 2 DP - 2022 Apr TI - Increased relative risk of delayed hemorrhage in patients taking anticoagulant/antiplatelet medications with concurrent aspirin therapy: implications for clinical practice based on 3-year retrospective analysis in a large health system. PG - 353-358 LID - 10.1007/s10140-021-02003-3 [doi] AB - PURPOSE: The incidence of delayed posttraumatic intracranial hemorrhage (DH) in patients on anticoagulant (AC) and antiplatelet (AP) medications, especially with concurrent aspirin therapy, is not well established, with studies reporting disparate results with between 1-10% risk of DH and 0-3% mortality. The purpose of this 3-year retrospective study is to evaluate the true risk of DH in patients on AP/AC medications with or without concurrent aspirin therapy. METHODS: One thousand forty-six patients taking AP and AC medications presenting to network emergency departments with head trauma who had repeat CT to evaluate for DH were included in the study. Repeat examinations were typically performed within 24 h (average follow-up time was 21 h and 99% were within 3 days). Mean time to DH was 20 h. All positive studies were reviewed by two board-certified neuroradiologists. Patients were excluded from the study if hemorrhage was retrospectively identified on the initial examination. Cases were reclassified as negative if hemorrhage on the follow-up examination was thought to be not present or artifactual. Cases were considered positive if the initial examination was negative and the follow-up examination demonstrated new hemorrhage. RESULTS: Overall, there was 1.91% incidence (20 patients) of DH and 0.3% overall mortality (3 patients). The group of patients taking warfarin or AP agents demonstrated a significantly higher rate of DH (3.2% compared to 0.9%) and higher mortality (0.9% compared to 0.0%) compared to the DOAC group (p < 0.01). The risk of DH in patients taking AC or AP agents with aspirin (13/20 cases) was significantly higher (RR 3.8, p < 0.01) than that of patients taking AC or AP alone (7/20 cases). CONCLUSION: The risk of DH was significantly higher in patients taking aspirin in addition to AC/AP medications. Repeat imaging should be obtained for trauma patients taking AC/AP agents with concurrent aspirin. The rate of DH was also significantly higher in patients taking warfarin or AP agents when compared to patients taking DOACs. Repeat examination should be strongly considered on patients taking warfarin or AP agents without aspirin. Given the relatively low risk of DH in patients taking DOACs alone, repeat imaging could be reserved for patients with external signs of trauma or dangerous mechanism of injury. CI - (c) 2021. American Society of Emergency Radiology. FAU - Chang, Warren AU - Chang W AUID- ORCID: 0000-0003-1308-5077 AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. warren.chang@ahn.org. FAU - Yin, Danielle AU - Yin D AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. FAU - Li, Charles AU - Li C AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. FAU - Weston, Brian AU - Weston B AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. FAU - Sohn, Albert AU - Sohn A AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. FAU - Wanamaker, Christian AU - Wanamaker C AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. FAU - Kulzer, Matthew AU - Kulzer M AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. FAU - Tragon, Tyson AU - Tragon T AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. FAU - Spearman, Michael AU - Spearman M AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. FAU - Eisenmenger, Laura AU - Eisenmenger L AD - School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA. FAU - Goldberg, Michael AU - Goldberg M AD - Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA. LA - eng GR - UL1 TR002373/TR/NCATS NIH HHS/United States PT - Journal Article DEP - 20220106 PL - United States TA - Emerg Radiol JT - Emergency radiology JID - 9431227 RN - 0 (Anticoagulants) RN - R16CO5Y76E (Aspirin) SB - IM MH - *Anticoagulants/adverse effects MH - *Aspirin/adverse effects MH - Hemorrhage/chemically induced MH - Humans MH - Retrospective Studies MH - Risk PMC - PMC8917980 MID - NIHMS1766236 OTO - NOTNLM OT - Anticoagulation OT - Antiplatelet OT - Aspirin OT - Computational tomography OT - Cost-effectiveness OT - Delayed hemorrhage OT - Emergency department OT - Intracranial hemorrhage OT - Trauma COIS- There are no conflicts of interest to disclose from any of the authors. EDAT- 2022/01/07 06:00 MHDA- 2022/03/16 06:00 PMCR- 2023/04/01 CRDT- 2022/01/06 06:13 PHST- 2021/09/21 00:00 [received] PHST- 2021/11/22 00:00 [accepted] PHST- 2022/01/07 06:00 [pubmed] PHST- 2022/03/16 06:00 [medline] PHST- 2022/01/06 06:13 [entrez] PHST- 2023/04/01 00:00 [pmc-release] AID - 10.1007/s10140-021-02003-3 [pii] AID - 10.1007/s10140-021-02003-3 [doi] PST - ppublish SO - Emerg Radiol. 2022 Apr;29(2):353-358. doi: 10.1007/s10140-021-02003-3. Epub 2022 Jan 6.