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Systematic Review and Meta-Analysis: Is Pre-Injury Antiplatelet Therapy Associated with Traumatic Intracranial Hemorrhage?
van den Brand, Crispijn L; Tolido, Tanya; Rambach, Anna H; Hunink, Myriam G M; Patka, Peter; Jellema, Korné.
Afiliação
  • van den Brand CL; 1 Department of Emergency Medicine, MC Haaglanden-Bronovo , The Hague, The Netherlands .
  • Tolido T; 2 Department of Cardiology, Canisius Wilhelmina Hospital , Nijmegen, The Netherlands .
  • Rambach AH; 1 Department of Emergency Medicine, MC Haaglanden-Bronovo , The Hague, The Netherlands .
  • Hunink MG; 3 Departments of Epidemiology and Radiology, Erasmus MC, Rotterdam, the Netherlands; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
  • Patka P; 4 Department of Emergency Medicine, Erasmus MC, Rotterdam, The Netherlands .
  • Jellema K; 5 Department of Neurology, MC Haaglanden-Bronovo , The Hague, The Netherlands .
J Neurotrauma ; 34(1): 1-7, 2017 01 01.
Article em En | MEDLINE | ID: mdl-26979949
The objective of this systematic review and meta-analysis is to evaluate whether the pre-injury use of antiplatelet therapy (APT) is associated with increased risk of traumatic intracranial hemorrhage (tICH) on CT scan. PubMed, Medline, Embase, Cochrane Central, reference lists, and national guidelines on traumatic brain injury were used as data sources. Eligible studies were cohort studies and case-control studies that assessed the relationship between APT and tICH. Studies without control group were not included. The primary outcome of interest was tICH on CT. Two reviewers independently selected studies, assessed methodological quality, and extracted outcome data. This search resulted in 10 eligible studies with 20,247 patients with head injury that were included in the meta-analysis. The use of APT in patients with head injury was associated with significant increased risk of tICH compared with control (odds ratio [OR] 1.87, 95% confidence interval [CI]1.27-2.74). There was significant heterogeneity in the studies (I2 84%), although almost all showed an association between APT use and tICH. This association could not be established for patients receiving aspirin monotherapy. When considering only patients with mild traumatic brain injury (mTBI), the OR is 2.72 (95% CI 1.92-3.85). The results were robust to sensitivity analysis on study quality. In summary, APT in patients with head injury is associated with increased risk of tICH; this association is most relevant in patients with mTBI. Whether this association is the result of a causal relationship and whether this relationship also exists for patients receiving aspirin monotherapy cannot be established with the current review and meta-analysis.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Inibidores da Agregação Plaquetária / Hemorragia Intracraniana Traumática / Anticoagulantes Tipo de estudo: Guideline / Observational_studies / Risk_factors_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2017 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Inibidores da Agregação Plaquetária / Hemorragia Intracraniana Traumática / Anticoagulantes Tipo de estudo: Guideline / Observational_studies / Risk_factors_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2017 Tipo de documento: Article