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

Abstract

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.

Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy

“… 38 , 39) Although there are a few reports that neither anticoagulant nor antiplatelet influence on the mortality and morbidity in patients with TBI, 40 – 42) most of the available data suggest that a pre-injury reception of either anticoagulant or antiplatelet agent increases the risk of poor outcome in patients with TBI, mainly resulting from larger or repeated intracranial hematoma. 43 – 52) It has been also reported that the history of anticoagulant is closely associated with the occurrence of talk and deteriorate. 53) …”

Acute Traumatic Brain Injury: Mortality in the Elderly

“…This might be explained in that the preoperative protocol dictates that an elevated international normalized ratio (INR) due to warfarin is to be treated and normalized before surgery is performed (8). The role of anticoagulation medicine in outcome after intracranial hemorrhage is still debated with some investigators (6) arguing that it does not have an adverse effect on outcome and some (12,20) stating the opposite.…”

Management of Traumatic Intracranial Hemorrhage on Anticoagulant Regiment: A Literature Review

“…The authors unfortunately did not specifically mention which agents were consumed by the subjects. This study found that poor Glasgow Outcome Scale (GOS) was more common in the oldest subgroup (≥ 85 yo), despite not statistically significant (p = 0.37) (Inamasu, J. 2010).…”