Antithrombotic agents intake prior to injury does not affect outcome after a traumatic brain injury in hospitalized elderly patients

Julien, J; Alsideiri, Ghusn; Marcoux, Judith; Hasen, Mohammed; Correa, José A.; Feyz, Mitra; Maleki, Mohammed; Guise, Élaine de

doi:10.1016/j.jocn.2016.12.032

Cited by 12 publications

(12 citation statements)

References 26 publications

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“…Patients with a pre-injury ASA-PS score of ≥ 3 were substantial (28%) compared to CENTER-TBI which was 11% (Steyerberg et al 2019); the latter is similar to the general trauma population admitted to OUH (10%) (Sovik et al 2014). The more silent comorbidity; antithrombotics, were used by 42% of our TBI patients > 50 years and this compares to other TBI studies, 33-47%, on the elderly population (Gaist et al 2017;Julien et al 2017;Narum et al 2016;Lenell et al 2019). In the total Norwegian population 18% ≥ 40 years use antithrombotic drugs (Berg et al 2017) in line with previously mentioned EU study (Steyerberg et al 2019).…”

Section: Discussionmentioning

confidence: 54%

Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway

et al. 2020

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Background: The vast majority of hospital admitted patients with traumatic brain injury (TBI) will have intracranial injury identified by neuroimaging, requiring qualified staff and hospital beds. Moreover, increased pressure in health care services is expected because of an aging population. Thus, a regular evaluation of characteristics of hospital admitted patients with TBI is needed. Oslo TBI Registry-Neurosurgery prospectively register all patients with TBI identified by neuroimaging admitted to a trauma center for southeast part of Norway. The purpose of this study is to describe this patient population with respect to case load, time of admission, age, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival. Methods: Data for 5 years was extracted from Oslo TBI Registry-Neurosurgery. Case load, time of admission, age, sex, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival was compiled and compared. Results: From January 1st, 2015 to December 31st, 2019, 2153 consecutive patients with TBI identified by neuroimaging were registered. The admission rate of TBI of all severities has been stable year-round since 2015. Mean age was 52 years (standard deviation 25, range 0-99), and 68% were males. Comorbidities were common; 28% with pre-injury ASA score of ≥3 and 25% used antithrombotic medication. The dominating cause of injury in all ages was falls (55%) but increased with age. Upon admission, the head injury was classified as mild TBI in 46%, moderate in 28%, and severe (Glasgow coma score ≤ 8) in 26%. Case load was stable without seasonal variation. Majority of patients (68%) were admitted during evening, night or weekend. 68% was admitted to intensive care unit. Length of hospital stay was 4 days (median, interquartile range 3-9). 30-day survival for mild, moderate and severe TBI was 98, 94 and 69%, respectively. Conclusions: The typical TBI patients admitted to hospital with abnormal neuroimaging were aged 50-79 years, often with significant comorbidity, and admitted outside ordinary working hours. This suggests the necessity for allhour presence of competent health care professionals.

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Section: Discussionmentioning

confidence: 54%

Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway

et al. 2020

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“…143 Still others have found that early aggressive treatment can mitigate any negative impact of antithrombotics on mortality or outcomes. 144,145 Thus, although antithrombotic therapies may not be associated with worse post-TBI outcomes in a setting in which patients receive rapid and aggressive treatment for hemorrhagic complications and in analyses that adjust for initial TBI severity, it is clear that anticoagulant therapy is associated with worse initial TBI severity, such as acute subdural hemorrhage after relatively minor trauma. 141,142,145,146 This conclusion is further supported by a study of 80 patients (all ages) with acute subdural hemorrhage reporting that initial hematoma volume and GCS are better predictors of hematoma expansion and outcome than age or antithrombotic therapy if patients are rapidly given appropriate agents to reverse coagulopathy.…”

Section: Neurocritical Care and Neurosurgical Management Issuesmentioning

confidence: 99%

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

Gardner

Dams-O’Connor

Morrissey

et al. 2018

Journal of Neurotrauma

310

286

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This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood ("geriatric TBI") rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults. Higher morbidity and mortality rates among older versus younger individuals with TBI may contribute to an assumption of futility about aggressive management of geriatric TBI. However, many older adults with TBI respond well to aggressive management and rehabilitation, suggesting that chronological age and TBI severity alone are inadequate prognostic markers. Yet there are few geriatric-specific TBI guidelines to assist with complex management decisions, and TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include under-representation of older adults in TBI research, lack of systematic measurement of pre-injury health that may be a better predictor of outcome and response to treatment than age and TBI severity alone, and lack of geriatric-specific TBI common data elements (CDEs). This review highlights the urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatric TBI prognostic models, and evidence-based geriatric TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatric TBI population.

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“…Similarly, the studies by Boltz et al and Julien et al reported no effect of preinjury anticoagulant or antiplatelet medications on the length of ICU stay or mechanical ventilation [23,24]. Coleman et al reported that taking preinjury clopidogrel did not affect the length of ICU stay, but did affect the total time spent in hospital [25], and Bonville et al also reported that preinjury antiplatelet medication affected the total hospital stay, but not the length of time spent in ICU [17].…”

Section: Discussionmentioning

confidence: 93%

Are Preinjury Anticoagulant and Antiplatelet Medications a Pitfall in the Bleeding Tendencies of Elderly Trauma Patients in Intensive Care?

Kim¹,

Sul²,

Lee³

et al. 2020

Preprint

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Purpose: The elderly are more likely to be on anticoagulant or antiplatelet medications, which increase bleeding. We aimed to determine the effect of preinjury anticoagulant or antiplatelet medications on required blood transfusions and the trauma outcomes of elderly patients.Methods: We retrospectively reviewed the medical records of all elderly trauma patients admitted to Chungbuk National University Hospital from January 2016 to June 2019. We compared the required number of blood transfusion units, complications, and mortality rate between those on anticoagulant or antiplatelet medications and those that were not, using the chi-squared test, independent t-test, liner regression analysis, and logistic regression analysis.Results: Out of 466 patients, 142 were on anticoagulant or antiplatelet medications while 324 were not. There was a significant statistical difference in the unit amount of red blood cells transfused within 4 hours of arriving at the hospital between the medicated and non-medicated groups (0.89 vs 1.43 units, respectively, p = 0.02); however, multivariate analysis showed no statistical difference (p = 0.28). The medication group showed a higher rate of complications compared to the non-medicated group (47.9% vs. 29.6%, respectively, p = 0.001), bleeding (17.6% vs 2.8%, respectively, p = 0.001), and pneumonia (24.4% vs 14.2%, respectively, p =0.01). There was no statistical difference in the mortality rate (16.9% vs. 22.2%, respectively, p = 0.21). Conclusion: Preinjury anticoagulant or antiplatelet medications in elderly trauma patients increased bleeding and complications such as pneumonia but did not affect transfusion requirement, or mortality rate.

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Antithrombotic agents intake prior to injury does not affect outcome after a traumatic brain injury in hospitalized elderly patients

Cited by 12 publications

References 26 publications

Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway

Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

Are Preinjury Anticoagulant and Antiplatelet Medications a Pitfall in the Bleeding Tendencies of Elderly Trauma Patients in Intensive Care?

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