A. Ngo1,3, A. LaRiccia1,2,3, J. Kuhlman1,3, J. Sarver1,3, S. Hyland4, M. Spalding1,2,3, J. Hill1 4OhioHealth Grant Medical Center,Department Of Pharmacy Services,Columbus, OHIO, USA 1OhioHealth Grant Medical Center,Division Of Trauma And Acute Care Surgery,Columbus, OHIO, USA 2OhioHealth Doctors Hospital,Department Of Surgery,Columbus, OHIO, USA 3Ohio University Heritage College of Osteopathic Medicine,Dublin, OHIO, USA
Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are attractive pain control adjuncts in the current climate of the opiate crisis. One side effect is the temporary inhibition of platelet aggregation in COX-1 inhibiting NSAIDs. Thus, increased bleeding is a concern when utilizing this type of pain control in trauma patients with intracranial hemorrhages (ICH). The primary purpose of this study is to assess the progression of ICH in blunt trauma patients who received NSAIDs during the period of hemorrhage monitoring. We hypothesize that the use of NSAIDs would not increase hemorrhage progression.
Methods: This is an IRB approved retrospective chart review of blunt trauma patients with CT diagnosed ICH (epidural, subdural, subarachnoid and/or intraparenchymal) at an urban level 1 trauma center from 6/1/2015 to 12/31/2018. Exclusion criteria included patients with bleeding disorders, pregnancy, home anticoagulation or antiplatelet use, death within 24 hours and prisoners. Progression of ICH was evaluated in single bleed type patients defined as progression of the ICH on repeat head CT as determined by the reading radiologist. Craniotomy procedures and mortality were analyzed with Chi-squared and Odds Ratio. NSAID use patterns were analyzed with the Fischer’s exact test with p<0.05 as significant.
Results: Overall 1233 patients over the 3.5 year timeframe met inclusion criteria. For analysis of bleed progression only patients with a single type of bleed were used, leaving a total of 737 patients. The increase in cumulative NSAID dose averages in 6 month intervals was not statistically significant (P =0.41). 4.8% of patients given NSAIDs had progression of ICH on CT compared to 9.2% of those not taking NSAIDs (P =0.49). 10.9% of patients given NSAIDs had a craniotomy, compared to 13.8% not given NSAIDs (P =40). Patients not taking NSAIDs had a 3.3 times increased likelihood of mortality (OR 3.3; 95% CI 1.4-7.7; P = 0.003).
Conclusion: NSAID use in patients with a single type of ICH did not worsen the bleed progression and could be safely used from our findings. Similarly the use of NSAIDs did not result in an increased number of craniotomies compared to those that did not receive NSAIDs. NSAID use in these patients had no negative effects on the odds of in hospital mortality. NSAID use in these patients should be a safe addition for pain control, even in the early phases of bleed monitoring without the risk of worsening ICH. Within our trauma ICH population the use of NSAIDs are trending up, and although not statistically significant, this is a positive sign our practitioners are using more pain control adjuncts.
