Safety of Nonsteroidal Anti‐Inflammatory Drug Use in Traumatic Brain Injury

BACKGROUND: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) after a traumatic brain injury (TBI) is controversial due to potential worsening of an intracranial hemorrhage (ICH). This study evaluated if NSAID use within 14 days of TBI was associated with a clinically significant progression of intracranial bleed (PIB). METHODS: A retrospective, propensity score-weighted study was conducted in adult patients with a TBI admitted to an American College of Surgeons Certified Level I Trauma Center. The NSAID group included patients who received at least one dose of an NSAID within 14 days of injury while admitted. The control group included patients who did not receive NSAIDs. The primary end point was incidence of a clinically significant PIB (decrease in the Glasgow Coma Score (GCS) > 2 and an increased or new ICH). Secondary outcomes included need for additional neurosurgical intervention and PIB on imaging regardless of GCS change. RESULTS: 978 patients were included: 284 in the NSAID group and 694 in the control group. Most patients had an Abbreviated Injury Score head > 2 (88%) and a subdural hematoma (57%). Fifty-two percent of patients had a mixed bleed. A clinically significant PIB occurred in 0.35% in the NSAID group and 1.2% in the control group (Hazards Ratio 0.1, 95% Confidence Interval 0.01-0.82, p = 0.032). There was no difference in additional neurosurgical operations or PIB regardless of GCS change. In the NSAID group, there was no significant difference in time from admission to NSAID administration between patients who experienced a PIB and those who did not have a PIB (1.9 days vs. 4.7 days, respectively, p = 0.06). CONCLUSION: In this single-center, retrospective, propensity score-weighted study, NSAIDs were not associated with an increased risk of clinically significant PIB in patients with acute TBI when administered within 14 days of injury. NSAIDs appear safe in the acute phase post-TBI. Prospective studies are needed to validate our results.