ABSTRACT
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Subject(s)
Humans , Middle Aged , Brain Injuries, Traumatic/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Intracranial Hemorrhages/drug therapy , Risk Factors , Brain Injuries/diagnostic imagingABSTRACT
INTRODUCCIÓN Y OBJETIVO: El uso de antiagregantes plaquetarios está aumentando, fundamentalmente en pacientes de edad avanzada en los que el traumatismo craneal es un motivo habitual de consulta en urgencias. En este contexto existe discordancia sobre el riesgo aumentado de lesión postraumática que supone la toma de antiagregantes. Por tanto, el objetivo de este estudio fue analizar los factores asociados con la presencia de sangrado intracraneal tras traumatismo craneoencefálico leve. PACIENTES Y MÉTODOS: Se diseñó un estudio retrospectivo, incluyendo todos aquellos pacientes atendidos en 2016 por traumatismo craneoencefálico leve (escala de coma de Glasgow 14-15), excluyendo los pacientes en tratamiento anticoagulante. Se realizó un análisis de regresión logística para analizar las variables asociadas con sangrado intracraneal. RESULTADOS: Quinientos sesenta y seis pacientes fueron incluidos. El 18% de los pacientes tomaba antiagregantes. La tomografía mostró lesión intracraneal hemorrágica en el 16,1%. Los factores asociados con sangrado intracraneal fueron: edad avanzada, escala de coma Glasgow<15, traumatismo de alta energía y toma de antiagregantes. DISCUSIÓN: La terapia antiagregante emerge como factor de riesgo de sangrado intracraneal tras traumatismo craneoencefálico leve, además de otros factores ya conocidos
Introduction and OBJECTIVE: The use of antiplatelet agents is increasing, mainly in elderly patients in whom cranial trauma is a frequent reason for consultation to the emergency department. In this context, discordances have been described regarding the increased risk of post-traumatic injury that involves taking antiplatelet drugs. Therefore, the objective of this present study was to analyse factors associated with intracranial bleeding after mild brain trauma. PATIENTS AND METHODS: A retrospective study was designed that included all patients who had consulted the emergency department during 2016 because of mild brain trauma (Glasgow coma scale 14-15) and excluded patients under anticoagulant therapy. A logistic regression analysis was performed to analyse the variables associated with intracranial bleeding. RESULTS: 566 patients were included in the study. 18% of them were taking antiplatelet drugs. Tomography showed haemorrhagic intracranial damage in 16.1%. Factors associated with intracranial bleeding were: advanced age, Glasgow coma scale < 15, high-energy trauma and antiplatelet therapy. DISCUSSION: Antiplatelet therapy emerges as a risk factor for intracranial bleeding after mild head trauma, in addition to other known factors
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Platelet Aggregation Inhibitors/therapeutic use , Intracranial Hemorrhages/drug therapy , Craniocerebral Trauma/complications , Retrospective Studies , Logistic Models , Risk Factors , Tomography, X-Ray Computed , Emergency Medical ServicesABSTRACT
INTRODUCTION AND OBJECTIVE: The use of antiplatelet agents is increasing, mainly in elderly patients in whom cranial trauma is a frequent reason for consultation to the emergency department. In this context, discordances have been described regarding the increased risk of post-traumatic injury that involves taking antiplatelet drugs. Therefore, the objective of this present study was to analyse factors associated with intracranial bleeding after mild brain trauma. PATIENTS AND METHODS: A retrospective study was designed that included all patients who had consulted the emergency department during 2016 because of mild brain trauma (Glasgow coma scale 14-15) and excluded patients under anticoagulant therapy. A logistic regression analysis was performed to analyse the variables associated with intracranial bleeding. RESULTS: 566 patients were included in the study. 18% of them were taking antiplatelet drugs. Tomography showed haemorrhagic intracranial damage in 16.1%. Factors associated with intracranial bleeding were: advanced age, Glasgow coma scale < 15, high-energy trauma and antiplatelet therapy. DISCUSSION: Antiplatelet therapy emerges as a risk factor for intracranial bleeding after mild head trauma, in addition to other known factors.
Subject(s)
Brain Concussion/complications , Intracranial Hemorrhages/chemically induced , Platelet Aggregation Inhibitors/adverse effects , Adult , Age Factors , Aged , Female , Glasgow Coma Scale , Humans , Intracranial Hemorrhages/surgery , Logistic Models , Male , Middle Aged , Platelet Aggregation Inhibitors/administration & dosage , Retrospective StudiesABSTRACT
INTRODUCTION: This study aimed to ascertain the associations of thromboelastography (TEG® ) and standard laboratory test (SLTs) values with the presence of bleeding in critically ill patients with known coagulopathy. METHODS: Three groups of coagulopathic patients with (a) hepatic failure, (b) postoperative period after prolonged cardiac surgery, and (c) complex abdominal surgery with sepsis were prospectively included in this study. On intensive care unit (ICU) admission, patients were stratified into two groups according to whether they had major bleeding (MB) (evident overt bleeding, important bleeding apparent on imaging studies, and/or need for moderate-massive blood transfusion and hemodynamic instability). Blood samples were drawn for the SLTs (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count, and fibrinogen level [Clauss]) and TEG whole blood coagulation assays. Receiver operating characteristic (ROC) curves were generated to determine the efficiency of TEG and SLTs for detecting bleeding. The correlations between SLTs and TEG parameters with similar coagulation profiles were evaluated by Spearman rank-order analysis. RESULTS: Eighty-three patients were included, and bleeding was confirmed in 45 (54%). The fibrinogen level demonstrated the best accuracy for detecting bleeding with an area under the curve and 95% confidence intervals [AUC (95% CI)] of 0.74 (0.63-0.85) with the best cutoff value of ≤ 2 g/L. Regarding TEG-MA, the AUC (CI) obtained with the optimal cutoff value of ≤ 51 mm was 0.68 (0.56-0.80). CONCLUSIONS: Both conventional clotting tests and TEG values were poorly associated with bleeding in this critically ill cohort of patients with coagulopathy.
