PMID- 36060453 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220907 IS - 2689-288X (Electronic) IS - 2689-288X (Linking) VI - 3 IP - 1 DP - 2022 TI - Pre-Injury Antiplatelet Therapy and Risk of Adverse Outcomes after Traumatic Brain Injury: A Systematic Review and Meta-Analysis. PG - 308-320 LID - 10.1089/neur.2022.0042 [doi] AB - There is an increasing number of trauma patients presenting on pre-injury antiplatelet (AP) agents attributable to an aging population and expanding cardio- or cerebrovascular indications for antithrombotic therapy. The effects of different AP regimens on outcomes after traumatic brain injury (TBI) have yet to be elucidated, despite the implications on patient/family counseling and the potential need for better reversal strategies. The goal of this systematic review and meta-analysis was to assess the impact of different pre-injury AP regimens on outcomes after TBI. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the OVID Medline, Embase, BIOSIS, Scopus, and Cochrane databases were searched from inception to February 2022 using a combination of terms pertaining to TBI and use of AP agents. Baseline demographics and study characteristics as well as outcome data pertaining to intracerebral hematoma (ICH) progression, need for neurosurgical intervention, hospital length of stay, mortality, and functional outcome were extracted. Pooled odds ratios (ORs) and mean differences comparing groups were calculated using random-effects models. Thirteen observational studies, totaling 1244 patients receiving single AP therapy with acetylsalicylic acid or clopidogrel, 413 patients on dual AP therapy, and 3027 non-AP users were included. No randomized controlled trials were identified. There were significant associations between dual AP use and ICH progression (OR, 2.81; 95% confidence interval [CI], 1.19-6.61; I (2), 85%; p = 0.02) and need for neurosurgical intervention post-TBI (OR, 1.61; 95% CI, 1.15-2.28; I (2), 15%; p = 0.006) compared to non-users, but not between single AP therapy and non-users. There were no associations between AP use and hospital length of stay or mortality after trauma. Pre-injury dual AP use, but not single AP use, is associated with higher rates of ICH progression and neurosurgical intervention post-TBI. However, the overall quality of studies was low, and this association should be further investigated in larger studies. CI - (c) Francois Mathieu et al., 2022; Published by Mary Ann Liebert, Inc. FAU - Mathieu, Francois AU - Mathieu F AD - Division of Neurosurgery, Department of Surgery, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. AD - Interdepartmental Division of Critical Care Medicine, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. FAU - Malhotra, Armaan K AU - Malhotra AK AD - Division of Neurosurgery, Department of Surgery, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. FAU - Ku, Jerry C AU - Ku JC AD - Division of Neurosurgery, Department of Surgery, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. FAU - Zeiler, Frederick A AU - Zeiler FA AD - Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada. AD - Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. AD - Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, Manitoba, Canada. AD - Centre on Aging, University of Manitoba, Winnipeg, Manitoba, Canada. AD - Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom. FAU - Wilson, Jefferson R AU - Wilson JR AD - Division of Neurosurgery, Department of Surgery, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. AD - Department of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada. FAU - Pirouzmand, Farhad AU - Pirouzmand F AD - Division of Neurosurgery, Department of Surgery, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. AD - Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. FAU - Scales, Damon C AU - Scales DC AD - Interdepartmental Division of Critical Care Medicine, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. AD - ICES, Toronto, Ontario, Canada. AD - Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. AD - Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. LA - eng PT - Journal Article DEP - 20220810 PL - United States TA - Neurotrauma Rep JT - Neurotrauma reports JID - 101773091 PMC - PMC9438446 OTO - NOTNLM OT - antiplatelet therapy OT - intracranial hemorrhage OT - mortality OT - traumatic brain injury COIS- F.A.Z. receives research support from the Manitoba Public Insurance (MPI) Neuroscience/TBI Research Endowment; the Health Sciences Centre Foundation Winnipeg; the Canada Foundation for Innovation (CFI; Project No.: 38583); Research Manitoba (Grant No.: 3906); the University of Manitoba VPRI Research Investment Fund (RIF); and the University of Manitoba Rudy Falk Clinician-Scientist Professorship. D.C.S. holds operating grants from the Canadian Institute for Health Research. EDAT- 2022/09/06 06:00 MHDA- 2022/09/06 06:01 PMCR- 2022/08/10 CRDT- 2022/09/05 03:54 PHST- 2022/09/05 03:54 [entrez] PHST- 2022/09/06 06:00 [pubmed] PHST- 2022/09/06 06:01 [medline] PHST- 2022/08/10 00:00 [pmc-release] AID - 10.1089/neur.2022.0042 [pii] AID - 10.1089/neur.2022.0042 [doi] PST - epublish SO - Neurotrauma Rep. 2022 Aug 10;3(1):308-320. doi: 10.1089/neur.2022.0042. eCollection 2022.