Abstract 3720: Antiplatelet Medication and Bleeding Complications with External Ventricular Drains
Introduction: External ventricular drains (EVD) are routinely used in the neurosurgical operating room and the neurointensive care unit to treat patients with severe traumatic brain injury and intracranial hemorrhages. EVD insertion has been associated with hemorrhagic complications in patients taking anticoagulants and standard of care dictates reversal of anticoagulation prior to EVD insertion. However, the risk of bleeding from EVD insertion in patients on antiplatelet medications is unknown. In this retrospective study, we determined the bleeding complication rates in patients on and off antiplatelet therapy.
Methods and Materials: Hospital procedure codes were searched to identify all patients who received an EVD from August 2008 and June 2011, regardless of indication. Computerized medical records, neuroimaging, and the Hartford Hospital Stroke Center Database were utilized to record medication use and bleeding complications. Patients who received anticoagulant therapy such as warfarin were excluded. A bleeding complication was defined as visible hemorrhage on a CT or MRI scan after EVD placement at any point along the EVD tract on any scan after placement. Review of neuroimaging was performed blinded to medication use. Analyses were performed to ascertain the correlation between antiplatelet therapy and bleeding complications following EVD placement.
Results: 163 patients met the inclusion criteria and 19 patients were taking an antiplatelet medication. The overall occurrence of bleeding complications after an EVD was 14 out of 163 (8.6%). The data suggest an association between antiplatelet medication use and EVD bleeding complications (6.9% in patients not on an antiplatelet medication vs 21.1% in patients taking an antiplatelet medication, p=0.062).
Conclusion: Although not statistically significant, this exploratory study identified a trend towards higher bleeding complications from EVD placement in patients on antiplatelet therapy. This is an important observation in reevaluating EVD insertion protocols. A larger study will likely establish statistical significance and can determine whether clinical outcomes were affected by bleeding complications. Future studies may then evaluate interventions to reduce bleeding (e.g. platelet transfusions for patients on antiplatelet therapy).
- © 2012 by American Heart Association, Inc.