Association of antiplatelet agents and intracranial hemorrhage in geriatric emergency department patients with head trauma from a fall.

Background: Older adults have the highest incidence of traumatic brain injury and are often on antiplatelet therapy. This study examines the association between preinjury antiplatelet agent use and intracranial hemorrhage in geriatric emergency department (ED) patients with blunt head injury from a fall. Methods: We conducted a secondary analysis of the GREAT STOP project, a large prospective study of geriatric ED patients who sustained head trauma. This project enrolled patients from two level one trauma centers over 1 year beginning 1 August 2019. Trained research associates enrolled patients who met study criteria. The primary outcome was intracranial hemorrhage. Rates of intracranial hemorrhage were compared between patients who were prescribed preinjury antiplatelet agents versus those who were not on any antiplatelet or anticoagulant therapy. Results: 3709 patients were included in the final analysis. Overall, 12.8% (475) had intracranial hemorrhage, and 6.4% (237) had a significant intracranial hemorrhage. Delayed intracranial hemorrhage occurred in 0.3% (10) of patients with one of these classified as a significant intracranial hemorrhage (1). Patients on aspirin or dual antiplatelet therapy had increased adjusted ORs of intracranial hemorrhage compared with patients not on antiplatelet therapy (1.4, 95% CI 1.1 to 1.8; and 1.7, 95% CI 1.1 to 2.6, respectively). Use of P2Y12 inhibitors alone did not show this effect (1.0, 95% CI 0.6 to 1.6). Conclusions: In geriatric ED patients who have sustained blunt head trauma from a fall, aspirin and especially dual antiplatelet therapy are associated with a significant risk of intracranial hemorrhage, while P2Y12 antiplatelet agents do not appear to carry this risk. The benefits from the use of these agents in older patients need to be weighed against their risk for fall and potential fall-related injury such as intracranial hemorrhage.