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Aspirin and the risk of intracranial complications following head injury
  1. Magdy Sakr, Consultant in Emergency Medicine,
  2. Libby Wilson, Clinical Research Fellow
  1. Department of Emergency Medicine, Manhester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; Kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether pre-injury aspirin increases the risk of intracranial complications following head injury. 124 papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. It is concluded that aspirin may increase the risk of developing intracranial complications. More research is needed.

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    Report by Magdy Sakr, Consultant in Emergency MedicineSearch checked by Libby Wilson, Clinical Research Fellow University of Coventry and Warwickshire, UK

    Clinical scenario

    A 65 year old man on aspirin presents to the Emergency Department having fallen sustaining a minor head injury. You wonder whether he is at higher risk of intracranial bleeding due to aspirin.

    Three part question

    In [adults with head injury] does [pre-injury aspirin] adversely [affect clinical outcome]?

    Search strategies

    Medline using the OVID interface 1966- August Week 4 2005 [exp brain injuries/ OR brain injur$.mp. OR exp craniocerebral trauma/ OR head injur$.mp.] AND [exp aspirin/ OR aspirin.mp. OR exp acetylsalicylic acid/ OR antithromb$.mp.] Limit to humans and English Embase 1980–2005 week 37 [craniocerebral trauma.mp. OR exp Head Injury/ OR exp Brain Injury/ OR brain injur$.mp] AND [aspirin.mp. or exp Acetylsalicylic Acid/ OR antithrom$.mp] LIMIT to Human, English Language and (adult <18 to 64 years> or aged <65+ years>) The Cochrane Library Issue 3 2005 Exp Aspirin [MeSH] AND exp brain injuries [MeSH] OR exp craniocerebral trauma [MeSH]

    Search outcome

    Altogether 103 were found in Medline and 104 in Embase. Three were relevant to the three part question, these are shown in the table below:

    Comments

    There was conflicting evidence that prior chronic use of aspirin increases the risk of intracranial haemorrhage following minor head injury. However, there is some evidence to suggest that there is increased risk of chronic subdural haemorrhage. A well designed prospective cohort study with adequate sample size and follow up is needed to address such important and common problem.

    CLINICAL BOTTOM LINE

    Pre-injury aspirin may increase the risk of intracranial complications following head injury. More research is needed.

    Table 4

    Report by Magdy Sakr, Consultant in Emergency MedicineSearch checked by Libby Wilson, Clinical Research Fellow University of Coventry and Warwickshire, UK

    References

    View Abstract

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