Antiplatelet and Anticoagulation Therapies Do Not Increase Mortality in the Absence of Traumatic Brain Injury

Ott, Mickey M.; Eriksson, Evert A.; VanderKolk, Wayne E.; Christianson, David; Davis, Alan L.; Scholten, Donald J.

doi:10.1097/ta.0b013e3181ad6600

Cited by 51 publications

(26 citation statements)

References 11 publications

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“…Anticoagulant therapy, in particular, has been associated with poorer outcomes after TBI, including increased incidence of intracranial hemorrhage (even among individuals with an initial Glasgow Coma Scale [GCS] score of 15), 14 longer lengths of hospital stay, and greater inhospital mortality. 14,15 The possibility that older adults are more vulnerable to more secondary complications after TBI is consistent with research indicating that younger people are more frequently seen in EDs and discharged, whereas older adults more often require hospital admission for TBIs of similar severity. 12 Although ambulatory guidelines provide for special considerations for the transport of older adults to a trauma center in the event of a TBI, 16 existing guidelines for the treatment of severe TBI do not address any special needs of the older adult population.…”

Section: Introductionsupporting

confidence: 64%

“…28 Additional indices of overall injury severity included total hospital length of stay (LOS) and SBP at admission to the ED. GCS scores were collapsed into the categories of mild (13)(14)(15), moderate (9)(10)(11)(12), and severe (3)(4)(5)(6)(7)(8). Maximum AIS score for the head region was retained in its original format, using the following scale: minor (1); moderate (2); serious (3); severe (4); critical (5); and unsurvivable (6).…”

Section: Dams-o'connor Et Almentioning

confidence: 99%

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Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers

Dams-O’Connor

Cuthbert

Whyte

et al. 2013

Journal of Neurotrauma

109

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Individuals 65 years of age and over have the highest rates of traumatic brain injury (TBI)-related hospitalizations and deaths, and older adults (defined variably across studies) have particularly poor outcomes after TBI. The factors predicting these outcomes remain poorly understood, and age-specific care guidelines for TBI do not exist. This study provides an overview of TBI in older adults using data from the National Trauma Data Bank (NTDB) gathered between 2007 and 2010, evaluates age group-specific trends in rates of TBI over time using U.S. Census data, and examines whether routinely collected information is able to predict hospital discharge status among older adults with TBI in the NTDB. Results showed a 20-25% increase in trauma center admissions for TBI among the oldest age groups (those > = 75 years), relative to the general population, between 2007 and 2010. Older adults ( > = 65 years) with TBI tended to be white females who have incurred an injury from a fall resulting in a ''severe'' Abbreviated Injury Scale (AIS) score of the head. Older adults had more in-hospital procedures, such as neuroimaging and neurosurgery, tended to experience longer hospital stays, and were more likely to require continued medical care than younger adults. Older age, injury severity, and hypotension increased the odds of in-hospital death. The public health burden of TBI among older adults will likely increase as the Baby Boom generation ages. Improved primary and secondary prevention of TBI in this cohort is needed.

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Section: Introductionsupporting

confidence: 64%

Section: Dams-o'connor Et Almentioning

confidence: 99%

Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers

Dams-O’Connor

Cuthbert

Whyte

et al. 2013

Journal of Neurotrauma

109

View full text Add to dashboard Cite

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“…The increase in blood transfusion in orthopaedic patients on APAs is also controversial [410,411]. However, the pre-injury use of APAs did not affect morbidity and mortality in retrospective studies in patients with pelvic fractures [412] or general trauma without brain injury [413], but did have an effect in patients with hip fractures [409]. On the contrary, even mild head trauma (GCS 14 to 15) while on APAs is associated with a high incidence of intracranial hemorrhage (ICH) [414-416], and a risk of delayed ICH in this group of patients mandates a longer period of observation [417,418].…”

Section: Resultsmentioning

confidence: 99%

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Bouillon²,

et al. 2013

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IntroductionEvidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved.MethodsThe multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.ResultsKey changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.ConclusionsA comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.Please see related letter by Morel et alhttp://ccforum.com/content/17/4/442

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“…In this study, patients taking antiplatelet or anticoagulant medication had longer hospitalizations (11.5 days vs 8.8 days, P = 0.04) but with no difference in intensive care unit length of stay (4.7 days vs 3.9 days, P = 0.5), Injury Severity Scores (21.4 vs 21.0, P = 0.76), or mortality (13.4% users vs 9.7% nonusers, P = 0.41). 97 Although this study was not on patients undergoing an elective surgical procedure, it is germane to the trauma surgical population.…”

Section: General/traumamentioning

confidence: 99%

Should More Patients Continue Aspirin Therapy Perioperatively?

et al. 2012

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Clinicians should employ a patient-specific strategy for perioperative aspirin management that weighs the risks of stopping aspirin with those associated with its continuation. Most patients, especially those taking aspirin for secondary cardiovascular prevention, should have their aspirin continued throughout the perioperative period. When aspirin is held preoperatively, the aspirin withdrawal syndrome may significantly increase the risk of a major thromboembolic complication. For many operative procedures, the risk of perioperative bleeding while continuing aspirin is minimal, as compared with the concomitant thromboembolic risks associated with aspirin withdrawal. Those cases where aspirin should be stopped include patients undergoing intracranial, middle ear, posterior eye, intramedullary spine, and possibly transurethral prostatectomy surgery.

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Antiplatelet and Anticoagulation Therapies Do Not Increase Mortality in the Absence of Traumatic Brain Injury

Cited by 51 publications

References 11 publications

Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers

Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Should More Patients Continue Aspirin Therapy Perioperatively?

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