Prehospital aspirin or clopidogrel use did not impact hemorrhage progression or need for neurosurgical intervention in blunt TBI patients otherwise meeting BIG1 criteria (0 NSI required among 58).
Cohort (n=236)
No
Does prehospital aspirin or clopidogrel use impact hemorrhage progression or the need for neurosurgery intervention in patients with blunt TBI otherwise meeting BIG1 criteria?
Prehospital aspirin or clopidogrel use does not appear to increase hemorrhage progression or the need for neurosurgical intervention in blunt TBI patients who otherwise meet BIG1 criteria.
Introduction The Brain Injury Guidelines (BIG) offer valuable criteria for identifying trauma patients requiring observation without immediate intervention. One variable evaluated in BIG is prehospital aspirin (ASA) or clopidogrel use. These patients are classified as BIG3 requiring repeat head CT and neurosurgery consultation. This study aims to investigate the rate of hemorrhage progression and neurosurgery intervention (NSI) in patients fulfilling all BIG1 criteria except prehospital ASA or clopidogrel use and how thromboelastography (TEG) with platelet mapping (PM) could be used to identify patients whose platelets remain uninhibited by prehospital antiplatelet therapy, suggesting safe BIG 1 management. Methods Retrospective review of data at a Level I trauma center between 2017 and 2022 focused on patients with traumatic brain injury (TBI) who reported prehospital ASA or clopidogrel use. Patients were categorized BIG 1, 2, or 3 based on initial CT, Glasgow Coma Scale admission, intoxication, skull fracture type, and presence/size of intracranial hemorrhages. Impact of antiplatelet agents on platelet function was analyzed using TEG with PM. Results We identified 236 blunt TBIs on prehospital ASA or clopidogrel. BIG scores, excluding antiplatelet medications, resulted in BIG1 (24.6%), BIG2 (19.5%), and BIG3 (55.9%) classifications. 32% of patients on prehospital clopidogrel showed ADP inhibition greater than 60%, whereas 61% of those on prehospital ASA had arachidonic acid inhibition greater than 60%. Of the 58 cases fulfilling BIG1 criteria in all parameters except prehospital ASA or clopidogrel use, all but one patient demonstrated a stable repeat head CT, and no NSI was required. Discussion Prehospital ASA or clopidogrel use did not impact hemorrhage progression or need for NSI in patients with blunt TBI otherwise meeting BIG1 criteria. TEG with PM provided valuable insights into platelet inhibition. Findings indicate the benefits of tailoring management strategies for trauma patients on antiplatelet therapy to optimize resource allocation and improve care. Level of evidence IV therapeutic/care management.
Okonya et al. (2026) conducted a cohort in Blunt traumatic brain injury (n=236). Prehospital aspirin or clopidogrel was evaluated on Hemorrhage progression and neurosurgery intervention (NSI). Prehospital aspirin or clopidogrel use did not impact hemorrhage progression or need for neurosurgical intervention in blunt TBI patients otherwise meeting BIG1 criteria (0 NSI required among 58).