Benefits and Risks of Anticoagulation Resumption Following Traumatic Brain Injury

Albrecht, Jennifer S.; Liu, Xinggang; Baumgarten, Mona; Langenberg, Patricia; Rattinger, Gail B.; Smith, Gordon S.; Gambert, Steven; Gottlieb, Stephen S.; Zuckerman, Ilene H.

doi:10.1001/jamainternmed.2014.2534

Cited by 59 publications

(52 citation statements)

References 34 publications

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“…2,3 The association between use of AT and clinical outcome among patients with previous intracranial hemorrhage/ICH have been examined in a few studies within recent years. [4][5][6][7] Overall, the findings seem to encourage the use of AT among patients surviving ICH because AT was associated with a lower risk of thromboembolic events without an associated increased risk of major bleeding. However, questions remain, as the available data are primarily restricted to patients with atrial fibrillation…”

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confidence: 80%

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Use of Antithrombotic Therapy and Long-Term Clinical Outcome Among Patients Surviving Intracerebral Hemorrhage

Ottosen

Grijota

Hansen

et al. 2016

Stroke

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Background and Purpose-The effectiveness and safety of antithrombotic therapy (AT) among patients with a history of intracerebral hemorrhage remain uncertain. We therefore determined the prevalence of indication for AT among patients hospitalized with first-time intracerebral hemorrhage and examined the impact of subsequent AT use on the long-term clinical outcome. Methods-We performed a population-based cohort study using nationwide Danish medical registries. Patients with risk of thromboembolism surviving the first 30 days after hospitalization because of intracerebral hemorrhage were identified and followed up. We estimated the hazard ratio of all-cause death, thromboembolic events, or major bleeding according to use of AT. Results-We identified 6369 patients between 2005 and 2013. Among these patients, 2978 (47%) had indication for AT, and during the follow-up, (median: 2.3 year) 1281 (43%) died, 497 (17%) had a thromboembolic event, and 536 (18%) had major bleeding. Postdischarge use of oral anticoagulation therapy among patients with indication for oral anticoagulation therapy was associated with a significant lower risk of death (adjusted hazard ratio, 0.59; 95% confidence interval, 0.43-0.82) and thromboembolic events (adjusted hazard ratio 0.58; 95% confidence interval, 0.35-0.97) and no increased risk of major bleeding (adjusted hazard ratio 0.65; 95% confidence interval, 0.41-1.02). In contrast, use of platelet inhibitors among patients with indication for platelet inhibitors was not related to statistically significantly improved clinical outcome. Conclusions-Approximately 1 of 2 patients surviving intracerebral hemorrhage had a high risk of thromboembolism.Postdischarge use of oral anticoagulation therapy was associated with a lower risk of all-cause mortality and thromboembolic events and no increased risk of major bleeding.

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confidence: 80%

“…[4][5][6][7]12 The studies differ in design, type of patients included, sample size, and level of details of the available data on patient characteristics and care (including drug use) and outcomes. The individual studies have specific set of strengths and limitations and are therefore complimentary from a methodological point of view.…”

Section: Discussionmentioning

confidence: 99%

Use of Antithrombotic Therapy and Long-Term Clinical Outcome Among Patients Surviving Intracerebral Hemorrhage

Ottosen

Grijota

Hansen

et al. 2016

Stroke

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“…Although this is contrary to literature that has reported higher incidence rates of TBI in men, it is consistent with two studies we conducted in Medicare beneficiaries hospitalized with TBI. 17,30-32 Most prior research has been conducted in younger populations therefore one explanation for this discrepancy is age. Women may also be more likely to seek medical attention following mild TBI.…”

Section: Discussionmentioning

confidence: 99%

Increased Rates of Mild Traumatic Brain Injury Among Older Adults in US Emergency Departments, 2009-2010

Albrecht

Hirshon

McCunn

et al. 2016

Journal of Head Trauma Rehabilitation

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Objective Estimate rates of emergency department (ED) visits for mild traumatic brain injury (TBI) among older adults. We defined possible mild TBI cases to assess underdiagnoses. Design Cross-sectional Setting National sample of ED visits 2009-2010 captured by The National Hospital Ambulatory Medical Care Survey. Participants Aged 65 and older Measurements Mild TBI defined by ICD-9-CM codes (800.0x-801.9x, 803.xx, 804.xx, 850.xx-854.1x, 950.1x-950.3x, 959.01) and a Glasgow Coma Scale score ≥14 or missing, excluding those admitted to the hospital. Possible mild TBI was defined similarly among those without mild TBI and with a fall or motor vehicle collision as cause of injury. We calculated rates of mild TBI and examined factors associated with diagnosis of mild TBI. Results Rates of ED visits for mild TBI were 386/100,000 among those 65-74; 777/100,000 among those 75-84; and 1,205/100,000 among those >84. Rates for women (706/100,000) were higher than for men (516/100,000). Compared to possible mTBI, diagnosis of mild TBI was more likely in the West (OR 2.31; 95%CI 1.02, 5.24) and less likely in the South/Midwest (OR 0.52; 95%CI 0.29, 0.96) than in the Northeast. Conclusions This study highlights an upward trend in rates of ED visits for mild TBI among older adults.

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“…A modeling study suggested that AF patients at higher risk of stroke would have to fall > 295 times/year before the risk of traumatic ICH would exceed the risk of ischemic stroke; yet, in older persons who fall, the mean number of falls is only 1.8/year 28, 29 . In older Medicare beneficiaries with traumatic brain injury on OAC, resumption of warfarin therapy following hospital discharge resulted in a 17% reduction in the combined outcome of ischemic and hemorrhagic stroke 30 . Based on these data, many investigators propose that high fall risk is not a reason to avoid OAC 10, 27, 28 .…”

Section: Pharmacologic Strategiesmentioning

confidence: 99%

Antithrombotic Management of Atrial Fibrillation in the Elderly

Edholm

Ragle

Rondina

2015

Medical Clinics of North America

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SYNOPSIS Compared to younger patients, older patients with atrial fibrillation (AF) have an increased risk of stroke and systemic embolism1, 2. For the majority of patients, oral anticoagulation (OAC) remains the most effective way to reduce this risk. While vitamin K antagonists (VKAs) have been used for decades, the more recent development of non-vitamin K dependent oral anticoagulants (NOACs) provides clinicians with broader selection of anticoagulants for stroke prevention in older AF patients. In this review, we discuss stroke risk-stratification tools for clinical decision making, review pharmacologic options for the prevention of stroke, and highlight several practical considerations to the use of these agents in older adults.

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Benefits and Risks of Anticoagulation Resumption Following Traumatic Brain Injury

Cited by 59 publications

References 34 publications

Use of Antithrombotic Therapy and Long-Term Clinical Outcome Among Patients Surviving Intracerebral Hemorrhage

Use of Antithrombotic Therapy and Long-Term Clinical Outcome Among Patients Surviving Intracerebral Hemorrhage

Increased Rates of Mild Traumatic Brain Injury Among Older Adults in US Emergency Departments, 2009-2010

Antithrombotic Management of Atrial Fibrillation in the Elderly

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