(1548) Effects of Reinitiating Antiplatelet Therapy After Traumatic Intracranial Hemorrhage

Introduction: Traumatic intracranial hemorrhage (ICH) affects over 50,000 people in the United States each year with 10% of patients on antiplatelet therapy (APT). There are limited studies that evaluate the risk and benefit of antiplatelet resumption after ICH, most of which focus on spontaneous ICH. The aim of this study was to evaluate the incidence of hematoma expansion in the antiplatelet cohort compared to the no antiplatelet cohort.

Methods: This was a retrospective matched cohort study to compare patients re-initiated on APT to patients not re-initiated after a traumatic ICH admitted to the trauma or neurosurgery services at an academic-affiliated health system between October 2012 through December 2022. Patients were matched based on glasgow coma scale, age, and location of hemorrhage. Inclusion criteria are age ≥18 years, acute traumatic ICH, and antiplatelet therapy prior to admission. Pregnant patients were excluded.

Results: The baseline characteristics were similar in both cohorts with majority of patients white males in their seventies with a mild TBI (GCS 13-15). Hypertension was more prevalent in the APT re-initiated group at 67.4% compared to 51.2% (p=0.04). There was no significant difference in intracranial hematoma expansion with a 4.7% difference between cohorts. Thrombotic complications was significantly higher in the antiplatelet reinitiated group at 14% vs 2.3% (p=0.002) in the not reinitiated group. This difference was largely driven by myocardial infraction as the most common type of thrombotic complication. 58.3% of thrombotic events occurred prior to APT initiation. There was no significant difference in either hematoma expansion or thrombotic events if the APT was re-initiated after 14 days from injury compared to re-initiated before 14 days. In hospital survival was significantly higher in the APT initiated cohort at 96.9% vs 77.8% (p < 0.001).

Conclusions: Re-initiating APT after a traumatic ICH was safe with no difference in hematoma expansion between cohorts. The rate of thrombotic events was significantly higher in the re-initiated APT cohort with majority of events occurring prior to restarting therapy. Patient specific factors along with risk and benefit evaluation of APT should be consider prior to re-initiating therapy after traumatic ICH.