Prognostic significance of preinjury anticoagulation in patients with traumatic brain injury: A systematic review and meta-analysis

Lim, Xin Tian; Ang, Eshen; Lee, Zong Xuan; Hajibandeh, Shahin; Hajibandeh, Shahab

doi:10.1097/ta.0000000000002976

Cited by 18 publications

(22 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1-3,7 Pre-injury anticoagulant use also has been shown to increase the severity of head injury and risk of mortality. 2,4-6 The current study, and existing studies, show an increased mortality in older, anticoagulated patients, which raises the question as to whether these criteria should be added as a TTA criteria. Callahan et al 10 examined the impact of using age of 65 years or older on antithrombotic medication as a criterion for TTA.…”

Section: Discussionmentioning

confidence: 66%

“…8 Pre-injury anticoagulant use has been associated with a 2.39 times increase in overall mortality in TBI patients. 6 An Eastern Association for the Surgery of Trauma (EAST) practice management guideline acknowledges this risk and urges for an expedited assessment and treatment in patients that are older and taking anticoagulant or antiplatelet agents, as these increase the risk of hemorrhage after an injury. 9 Anticoagulated patients with suspected TBI were previously triaged as a second tier trauma team activation (TTA) at the study institution.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A “GAP” in Activation: A Better Way to Manage Geriatric and Anticoagulated Patients with Head Trauma

Lee

Khan

Brockman

et al. 2022

The American Surgeon

View full text Add to dashboard Cite

Background Older age and anticoagulant use have been associated with worse outcomes in trauma. At the study institution, elderly and anticoagulated patients with suspected traumatic brain injury (TBI) were previously triaged as a second tier trauma team activation (TTA) with a high rate of over-triage. A novel “GAP” (Geriatric or Anticoagulated Pathway) alert was created to streamline care delivery to these patients. The purpose of the study is to assess the efficacy and outcomes of the GAP alert. Methods A retrospective review was conducted on adult patients presenting to a level-1 trauma center from 1/2018-12/2020. The GAP alert was implemented in 2/2018. The GAP alert group was compared to the second tier TTA group. Results 1743 patients were identified. 504 (29%) received a GAP alert. GAP alert patients were older (79 years vs 47 years, P < .0001), had a lower injury severity score (ISS) (8.6 vs 9.9, P = .006), and had a higher rate of pre-injury anticoagulant use (28.4% vs 2.5%, P < .0001). The in-hospital mortality was higher in the GAP group (2.4% vs .7%, P = .004). On multivariable logistic regression, GAP alert was not identified as a predictor of mortality. Age, ISS, and pre-injury anticoagulant use predicted mortality. During the study period, the number of GAP alerts increased ( B = .15, P = .003) and the number of second tier TTAs decreased ( B = −.33, P < .0001). Conclusion Implementation of the GAP alert led to a decrease in trauma resource utilization while providing timely diagnosis and treatment of geriatric patients or those on anticoagulation medication with suspected TBI.

show abstract

Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

A “GAP” in Activation: A Better Way to Manage Geriatric and Anticoagulated Patients with Head Trauma

Lee

Khan

Brockman

et al. 2022

The American Surgeon

View full text Add to dashboard Cite

show abstract

“…Like antiplatelet drugs, many patients who suffer TBI are now on anticoagulants, with an increasing proportion on direct oral anticoagulants (DOAC) rather than vitamin K antagonists such as warfarin. One systematic review showed that pre‐injury anticoagulation was associated with an increased mortality risk (OR 2.39 (95%CI 1.63–3.50); p < 0.00001); however, only a small minority of patients were taking a DOAC (5%) with the remainder taking vitamin K antagonists [27]. A small cohort study focusing on patients with minor head injury taking a DOAC showed an increase in the incidence of adverse outcomes, defined as a composite of requirement for neurosurgery, intracranial haemorrhage or death (3.4% (95%CI 1.4–8.0%)) [28], compared with patients who were not anticoagulated.…”

Section: Transfusion and Coagulationmentioning

confidence: 99%

Management of traumatic brain injury: a narrative review of current evidence

Wiles

2022

Anaesthesia

View full text Add to dashboard Cite

Globally, approximately 70 million people sustain traumatic brain injury each year and this can have significant physical, psychosocial and economic consequences for patients, their families and society. The aim of this review is to provide clinicians with a summary of recent studies of direct relevance to the management of traumatic brain injury in order to promote best clinical practice. The use of tranexamic acid in the management of traumatic brain injury has been the focus of several studies, with one large randomised controlled trial suggesting a reduction in all-cause mortality within 24 h of injury. The use of therapeutic hypothermia does not improve neurological outcomes and maintenance of normothermia remains the optimal management strategy. For seizure management, levetiracetam appears to be as effective as phenytoin, but the optimal dose remains unclear. There has been a lack of clear outcome benefit for any individual osmotherapy agent, with no difference in mortality or neurological recovery. Early tracheostomy (< 7 days from injury) for patients with traumatic brain injury is associated with a reduction in the incidence of ventilator-associated pneumonia and duration of mechanical ventilation, critical care and hospital stay. Further research is needed in order to determine the optimal package of care and interventions. There is a need for research studies to focus on patient-centred outcome measures such as long-term neurological recovery and quality of life.

show abstract

“…Traumatic brain injury (TBI) is often described as an insult due to a bump, blow or jolt to the head which leads to impairment of brain function (1). The spectrum of TBI can range from mild alteration in consciousness to a severe comatose state or death with or without evidence of intracranial hemorrhage (ICH) (2).…”

Section: Introductionmentioning

confidence: 99%

“…In the case of patients sustaining TBI, research suggests that preinjury use of anticoagulants (12) is a significant risk factor for developing ICH after TBI whereas corresponding evidence for antiplatelet drugs is ambiguous (13,14). Recent meta-analysis studies have assessed the impact of preinjury anticoagulation on outcomes of general trauma and TBI patients and have noted significantly increased mortality in anticoagulant users as compared to controls (1,10). However, similar evidence for antiplatelet drugs is scarce.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Preinjury Use of Antiplatelet Drugs on Outcomes of Traumatic Brain Injury: A Systematic Review and Meta-Analysis

2022

View full text Add to dashboard Cite

ObjectiveThe study aimed to compare outcomes of traumatic brain injury (TBI) in patients on pre-injury antiplatelet drugs vs. those, not on any antiplatelet or anticoagulant drugs.MethodsPubMed, Embase, and Google Scholar databases were searched up to 15th May 2021. All cohort studies comparing outcomes of TBI between antiplatelet users vs. non-users were included.ResultsTwenty studies were included. On comparison of data of 2,447 patients on pre-injury antiplatelet drugs with 4,814 controls, our analysis revealed no statistically significant difference in early mortality between the two groups (OR: 1.30 95% CI: 0.85, 1.98 I2 = 80% p = 0.23). Meta-analysis of adjusted data also revealed no statistically significant difference in early mortality between antiplatelet users vs. controls (OR: 1.24 95% CI: 0.93, 1.65 I2 = 41% p = 0.14). Results were similar for subgroup analysis of aspirin users and clopidogrel users. Data on functional outcomes was scarce and only descriptive analysis could be carried out. For the need for surgical intervention, pooled analysis did not demonstrate any statistically significant difference between the two groups (OR: 1.11 95% CI: 0.83, 1.48 I2 = 55% p = 0.50). Length of hospital stay (LOS) was also not found to be significantly different between antiplatelet users vs. non-users (MD: −1.00 95% CI: −2.17, 0.17 I2 = 97% p = 0.09).ConclusionOur results demonstrate that patients on pre-injury antiplatelet drugs do not have worse early mortality rates as compared to patients, not on any antiplatelet or anticoagulant drugs. The use of antiplatelets is not associated with an increased need for neurosurgical intervention and prolonged LOS.

show abstract

Prognostic significance of preinjury anticoagulation in patients with traumatic brain injury: A systematic review and meta-analysis

Cited by 18 publications

References 65 publications

A “GAP” in Activation: A Better Way to Manage Geriatric and Anticoagulated Patients with Head Trauma

A “GAP” in Activation: A Better Way to Manage Geriatric and Anticoagulated Patients with Head Trauma

Management of traumatic brain injury: a narrative review of current evidence

The Impact of Preinjury Use of Antiplatelet Drugs on Outcomes of Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About