Clinical outcomes in patients on preinjury ibuprofen with traumatic brain injury Bardiya Zangbar, M.D., Viraj Pandit, M.D., Peter Rhee, M.D., Mazhar Khalil, M.D., Narong Kulvatunyou, M.D., Terence O’Keeffe, M.B., Ch.B., Andrew Tang, M.D., Lynn Gries, M.D., Donald J. Green, M.D., Randall S. Friese, M.D., Bellal Joseph, M.D.* Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ, USA KEYWORDS: Ibuprofen; Motrin; Nonsteroidal anti- inflammatory drugs; Traumatic brain injury; Repeat head computed tomography; Neurosurgical Intervention Abstract BACKGROUND: The aim of our study was to evaluate the clinical outcomes in patients on preinjury Ibuprofen with traumatic brain injury. METHODS: We performed a 2-year analysis of all patients on prehospital Ibuprofen with traumatic brain injury and intracranial hemorrhage. Patients on preinjury Ibuprofen were matched using propen- sity score matching to patients not on Ibuprofen in a 1:2 ratio for age, Glasgow Coma Scale, head- abbreviated injury scale, injury severity score, International Normalized Ratio, and neurologic exami- nation. Outcome measures were progression on repeat head computed tomography (RHCT) and neuro- surgical intervention. RESULTS: A total of 195 matched (Ibuprofen 65, no-Ibuprofen 130) patients were included. There was no difference in the progression on RHCT (Ibuprofen 18% vs no-Ibuprofen 24%; P 5 .50). The neurosurgical intervention rate was 18.9% (n 5 37). There was no difference for need for neurosurgical intervention (26% vs 16%; P 5 .10) between the 2 groups. CONCLUSIONS: In a matched cohort of trauma patients, preinjury Ibuprofen use was not associated with progression of initial intracranial hemorrhage and the need for neurosurgical intervention. Prein- jury use of Ibuprofen as an independent variable should not warrant the need for a routine RHCT scan. Published by Elsevier Inc. Nonsteroidal anti-inflammatory drugs (NSAIDs) consti- tute one of the most widely used class of drugs, with more than 70 million prescriptions and more than 30 billion over- the-counter tablets sold annually in the United States. 1 Many people take Ibuprofen or other NSAIDs for rheu- matic disorders, headache, musculoskeletal problem, and pain control. The antiplatelet effect of nonsalicylate NSAIDs such as Ibuprofen as a reversible cyclooxygenase inhibitor has been widely assessed in both in vitro and in vivo studies. 2–4 Based on these studies, they are often withdrawn 7 or more days before surgery to avoid potential bleeding complications. 5 With the increase in trends of medical treatment by NSAIDs among US population, 6 a greater proportion of the traumatic brain injury (TBI) patients are visiting trauma There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs. Oral presentation at the 66th Annual Southwestern Surgical Congress, April 13–16, 2014, Scottsdale, Arizona. * Corresponding author. Tel.: 11-520-626-5056; fax: 11-520-626- 5016. E-mail address: bjoseph@surgery.arizona.edu Manuscript received May 1, 2014; revised manuscript May 11, 2014 0002-9610/$ - see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.amjsurg.2014.05.027 The American Journal of Surgery (2014) -, -–-