Korean J Neurotrauma.  2016 Oct;12(2):61-66. 10.13004/kjnt.2016.12.2.61.

The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury

• Han H
• Koh EJ
• Choi H
• Kim BC
• Yang SY
• Cho KT

• KMID: 2356774
• DOI: http://doi.org/10.13004/kjnt.2016.12.2.61

Abstract

OBJECTIVE
Traditionally, it is generally recommended that antiplatelet agent should be discontinued before surgery. However, decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) is performed emergently in most cases. Therefore, DC cannot be delayed to the time when the effect of antiplatelet agent on bleeding tendency dissipates. In this study, we evaluated the effect of preinjury antiplatelet therapy on hemorrhagic complications after emergent DC in patients with TBI.
METHODS
We retrospectively investigated patients with TBI who underwent emergent DC between 2006 and 2015. The patients were separated into two groups according to the use of preinjury antiplatelet agent: group 1 (patients taking antiplatelet agent) and group 2 (patients not taking antiplatelet agent). The rate of hemorrhagic complications (postoperative epidural or subdural hemorrhage, newly developed, or progression of preexisting contusion or intracerebral hemorrhage within the field of DC) and the rate of reoperation within 7 days after DC were compared between two groups.
RESULTS
During the study period, DC was performed in 90 patients. Of them, 19 patients were taking antiplatelet agent before TBI. The rate of hemorrhagic complications was 52.6% (10/19) in group 1 and 46.5% (33/71) in group 2 (p=0.633). The rate of reoperation was 36.8% (7/19) in group 1 and 36.6% (26/71) in group 2 (p=0.986). No statistical difference was found between two groups.
CONCLUSION
Preinjury antiplatelet therapy did not influence the rate of hemorrhagic complications and reoperation after DC. Emergent DC in patients with TBI should not be delayed because of preinjury antiplatelet therapy.

Keyword

Brain injuries; Decompressive craniectomy; Platelet aggregation inhibitors; Postoperative hemorrhage

MeSH Terms

Brain Injuries*
Cerebral Hemorrhage
Contusions
Decompressive Craniectomy*
Hematoma, Subdural
Hemorrhage
Humans
Platelet Aggregation Inhibitors
Postoperative Hemorrhage
Reoperation
Retrospective Studies
Platelet Aggregation Inhibitors

Figure

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  FIGURE 1 (A) The immediate postoperative computed tomography (CT) scan shows epidural hemorrhage (EDH) of maximal thickness of less than 10 mm. (B) CT scan performed when the intracranial pressure was more than 25 mmHg shows increased thickness of EDH compared with that in the immediate postoperative CT scan.

• 

  FIGURE 2 (A) Preoperative computed tomographic (CT) scan shows no hemorrhagic contusion. (B) The immediate postoperative CT scan shows progression of hemorrhagic contusion within the field of decompressive craniectomy.

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