Advanced Age and Preinjury Warfarin Anticoagulation Increase the Risk of Mortality After Head Trauma

Franko, Jan; Kish, Karen J; O’Connell, Brendan G.; Subramanian, Sujata; Yuschak, James V.

doi:10.1097/01.ta.0000224220.89528.fc

Cited by 197 publications

(121 citation statements)

References 13 publications

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“…Warfarin is known to have unfavorable effects, but whether the use of AP agents is associated with unfavorable outcomes remains controversial. [2][3][4][5][6]12,13) Therefore, the adverse effects of AP and AC agents must be evaluated separately in future studies. We combined AP and AC agents mainly because of the small number of patients in each age group.…”

Section: Discussionmentioning

confidence: 99%

“…10) Many clinical studies of geriatric TICH have regarded patients aged AE65 years as a single homogeneous group, 2,5,6) and few studies have considered the possible heterogeneity within the population. 4,11,12) However, the demographic characteristics as well as clinical outcomes are likely to differ substantially between hexagenarians and octogenarians after fallrelated TICH. In addition, preinjury medication with anti-platelet/anti-coagulant (AP/AC) agents, which are commonly prescribed to treat or prevent cerebro-and cardiovascular diseases, may be associated with unfavorable outcomes in elderly patients with TICH.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, preinjury medication with anti-platelet/anti-coagulant (AP/AC) agents, which are commonly prescribed to treat or prevent cerebro-and cardiovascular diseases, may be associated with unfavorable outcomes in elderly patients with TICH. [2][3][4][5][6]9) The present study divided elderly patients with fall-related TICH into 3 age groups according to the Centers for Disease Control and Prevention (CDC) classification, 1) and evaluated intergroup differences in the demographics and outcomes at discharge, as well as investigating whether the use of AP/AC agents was associated with unfavorable outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Inamasu

Nakatsukasa

Kuramae

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Ground-level fall is the most common cause of traumatic intracranial hemorrhage (TICH) in the elderly. Many studies on geriatric TICH have regarded patients aged AE65 years as a single group, but substantial heterogeneity is likely to exist within this population. Eighty-two elderly patients with fall-related TICH treated in our institution during a 6-year period were stratified into 3 age groups (65-74, 75-84, and AE85 years), and intergroup differences in the demographics and outcomes at discharge were evaluated. The influence of the use of anti-platelet/anti-coagulant (AP/AC) agent on outcomes was also investigated. Comparison of demographic variables demonstrated significant differences in the frequency of preinjury alcohol consumption and use of AP/AC agents between the 3 groups, indicating that the causes or triggers of fall might be substantially different between the 65-74 years group and the other two groups combined. The frequency of unfavorable outcomes increased with age, and the increase was statistically significant. The 82 patients were divided into two subgroups depending on the use of AP/AC agents. The outcomes of the AE85 years group taking AP/AC agents were particularly poor compared with those of the AE85 years group not using AP/AC agents. Advancing age may be associated with unfavorable outcomes in elderly patients with fall-related TICH, and patients aged AE85 years taking AP/AC have the greatest risk of unfavorable outcomes. Physicians must consider the risk/benefit analysis before prescribing AP/AC agents to patients aged AE85 years.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Inamasu

Nakatsukasa

Kuramae

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…6 Injury occurring while medically anticoagulated is associated with a worse outcome. [7][8][9] Patients having a TBI while anticoagulated also experience significant morbidity. 10 Traumatic brain injury in anticoagulated patients occurs not only acutely but can also develop more slowly and be identified in a delayed fashion.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Fresh Frozen Plasma Infusion is Ineffective in Reversing Warfarin Anticoagulation and Preventing Delayed Intracranial Hemorrhage After Falls

Reddy

Sharma

Grotts

et al. 2015

The Neurohospitalist

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Background: Elderly patients, with considerable fall risk, are increasingly anticoagulated to prevent thromboembolic disease. We hypothesized that a policy of prophylactic fresh frozen plasma (FFP) infusion in patients having falls would reverse vitamin K antagonists (VKAs) and that reversal would decrease delayed intracranial hemorrhage (ICH). Methods: A retrospective review of patients with trauma admitted to a level 2 community trauma center was performed from January 2010 until November 2012. Inclusion criteria were: ground level fall (GLF) with suspected head trauma, on VKA, an international normalized ratio (INR) of >1.5, and a negative head computed tomography (CT). Patients were transfused with FFP to a goal INR of <1.5 while observed. Patients were classified as reversed (REV) if the lowest INR achieved within 4 to 24 hours after initial INR was <1.5 or unreversed (NREV) if lowest INR achieved was >1.5. Chi-square and logistic regression were performed. Results: A total of 194 patients met the criteria. In all, 43 (22%) patients were able to be REV, and 151 (78%) patients remained NREV. Unreversed patients were male and younger (P < .05). There was no difference in mean FFP received. Unreversed patients had a higher initial INR of 3.0 compared to REV patients (2.5; P ¼ .018). One patient developed a delayed ICH and belonged to the REV group. Conclusion: The incidence of delayed hemorrhage was 0.5%. A strategy of prophylactic FFP infusion was ineffective in VKA reversal. We recommend against prophylactic infusion of FFP during a period of observation for patients on VKA with suspected head trauma and a negative initial CT.

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“…In case of head injuries situation is different. Even initially only slightly increased blood loss results in increase in the morality threefold reaching 25-50% (21,22).…”

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confidence: 99%

Trauma in the Aged

Brongel¹,

Hładki²,

Grodzicki³

et al. 2007

Polish Journal of Surgery

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After accidents, elderly patients (aged 75 years and older) have been demonstrated to have increased mortality rates after trauma, however, the prognosis of those patients surviving their hospitalization is unknown. We hypothesized that surviving elderly patients would also have decreased functional outcomes. The aim of the study. This study examined the outcome of elderly patients exposed to varying trauma relative to all trauma patients. Material and methods. This was a retrospective study of 5046 patients with trauma in 2001-2005 treated. 972 of these patients were aged 75 or more. Data included demographics, risks factors, cause of trauma, operative or conservative management and result of treatment. Results. Mechanisms of injury were falls (almost 90%), motor vehicle collisions (8%) and other. Statistical differences in the mechanisms of trauma between the studied and younger groups were observed. The mortality rate was doubled in the older group. Almost 2/3 of the patients underwent surgery. The strategy of management and treatment of elderly trauma patients has not been studied in the literature. This group may require special management and monitoring, and if possible, noninvasive modes of treatment. There are big advantages by aggressive, operative treatment of oldest patients, but is the "thin red line" in profits and loss in this group. Conclusions. In our opinion, it is necessity to operate on all elderly patients in good overall condition who were mobile and of good mental status prior to the accident, status, but we do not recommend operations in low-risk patients or those with bad prognosis for successful rehabilitation. Key words: elderly, functional outcome, risk of operation, trauma in the aged POLSKI PRZEGLĄD CHIRURGICZNY 10.2478/v10035-007-0017-7 2007 Similar to other countries, in Poland, as in other countries, the elderly population continues to rise. The percentage of people over 60 doubled within last 50 years (rose from 8.3 in 1950 to 17.6 in 2000), and nowadays, the group of people over 75 constitute 4% of the entire population.According to statistical data from GUS, a typical Pole suffers from 3.8 chronic diseases, with cardiovascular disorders playing prominent role (1, 2). They are diagnosed in 75% of elderly people. Elderly patients are commonly affected by disease that significantly affect their quality of life, such as degenerative arthropathies, eye and ear dysfunction and mobility problems. Musculoskeletal, respiratory, and digestive disorders affect 68%, 46%, and 34% of the elderly population, respectively. Diabetes mellitus, a disease of modern civilization, affects about 40% of population over 65. It results in an increased risk of infectious complications and delayed bone healing. Obesity affects the same group of patients and worsens prognosis, which results in an increased number of complications, prolongs hospitalization, lengthens mechanical ventilation time and increases mortality (3). Only about 20% of elderly people do not report Unauthenticated Download Date | 5/...

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Advanced Age and Preinjury Warfarin Anticoagulation Increase the Risk of Mortality After Head Trauma

Abstract: Both age and warfarin anticoagulation are independent predictors of mortality after blunt TBI. Warfarin anticoagulation carries a six-fold increase in TBI mortality. Age over 70 years and excessive anticoagulation are associated with higher mortality, as well.

Cited by 197 publications

References 13 publications

Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Prophylactic Fresh Frozen Plasma Infusion is Ineffective in Reversing Warfarin Anticoagulation and Preventing Delayed Intracranial Hemorrhage After Falls

Trauma in the Aged

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