The effect of preinjury anticoagulation on mortality in trauma patients: A systematic review and meta-analysis

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

doi:10.1016/j.injury.2020.06.010

Cited by 13 publications

(17 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, if tranexamic acid is effective in mild TBI patients, then future studies should consider prognostic modelling to identify which patients are likely to bene t most from early treatment, and which are not, whilst also accounting for the cost-effectiveness. Older age, lower GCS scores (13)(14) and anticoagulant use are all associated with higher mortality risk following mild TBI. 4,11,14 A prognostic model may help de ne a mortality risk 'threshold' at which tranexamic is cost-effective, or identify subgroups of mild TBI patients who are more likely to bene t from treatment.…”

Section: Future Researchmentioning

confidence: 99%

“…Older age, lower GCS scores (13)(14) and anticoagulant use are all associated with higher mortality risk following mild TBI. 4,11,14 A prognostic model may help de ne a mortality risk 'threshold' at which tranexamic is cost-effective, or identify subgroups of mild TBI patients who are more likely to bene t from treatment.…”

Section: Future Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…4,9−11 They are also more likely to experience intracranial bleeding, likely due to changes in anatomy, and a greater use of anticoagulant and antiplatelet drugs. [12][13][14] Due to the elevated risk of intracranial bleeding in older adults there may be justi cation for tranexamic acid to be provided as a preventative treatment prior to onset of intracranial bleeding, rather than after it being observed, by which time it will usually be too late.The CRASH-4 randomised controlled trial is planned to evaluate an intramuscular injection of tranexamic acid for symptomatic mild head injury in older adults, aged 70 and above (NCT04521881). 15 The pilot phase of the trial has begun recruiting with a target of 500 patients, and funding is being sought for a full randomised controlled trial.This study is an early economic evaluation to evaluate the potential cost-effectiveness of tranexamic acid in older mild TBI patients, and to consider the potential treatment effects required for it to be cost-effective for mild TBI patients aged 70 and above.…”

mentioning

confidence: 99%

See 3 more Smart Citations

A cost-effectiveness and value of information analysis to inform future research of tranexamic acid for older adults experiencing mild traumatic brain injury

Williams

Ker

Roberts

et al. 2021

Preprint

View full text Add to dashboard Cite

Background Tranexamic acid reduces head injury deaths in patients with CT scan evidence of intracranial bleeding after mild traumatic brain injury (TBI). However, the cost-effectiveness of tranexamic acid for people with mild TBI in the pre-hospital setting, prior to CT scanning, is uncertain. A large randomised controlled trial (CRASH-4) is planned to address this issue, but the economic justification for it has not been established. The aim of the analysis was to estimate the likelihood of tranexamic acid being cost-effective given current evidence, the treatment effects required for cost-effectiveness, and the expected value of performing further research. Methods An early economic decision model compared usual care for mild TBI with and without tranexamic acid, for adults aged 70 and above. The evaluation was performed from a UK healthcare perspective over a lifetime time horizon, with costs reported in 2020 pounds (GBP) and outcomes reported as quality adjusted life years (QALYs). All analyses used a £20,000 per QALY cost-effectiveness threshold. Results In the base case analysis, tranexamic acid was associated with an incremental cost-effectiveness ratio of £4,994 per QALY gained, and was 85% likely to be cost-effective in the base case probabilistic sensitivity analysis. The value of perfect information was £13.2 million, and the value of perfect information for parameters that could be collected in a trial was £12.4 million. The all-cause mortality risk ratio for tranexamic acid and the functional outcomes following TBI had the most impact on cost-effectiveness. Conclusions Tranexamic acid can be cost-effective at a very modest treatment effect, and there is a high value of performing future research in the UK. The value in a global context is likely to be far higher.

show abstract

Section: Future Researchmentioning

confidence: 99%

Section: Future Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

A cost-effectiveness and value of information analysis to inform future research of tranexamic acid for older adults experiencing mild traumatic brain injury

Williams

Ker

Roberts

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Only one systematic review has been published on the relationship between peri-injury anticoagulation and outcomes in trauma patients (11). There is little evidence to demonstrate how this relationship might have been affected by head injuries sustained.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in terms of morbidity and mortality among elderly head injury patients on pre-injury anticoagulation: A systematic review protocol

Ogbu

2022

Preprint

View full text Add to dashboard Cite

Background: The global burden of traumatic brain injuries continues to remain grossly underestimated and is thought to cost about US$400 billion annually. Elderly individuals have the highest age-specific rates of TBIs and are more likely to take anticoagulant medication than other age groups and are therefore theoretically at a higher risk of morbidity and mortality following head injuries. However, the evidence for these worse outcomes is at best unclear, and this has a significant impact on decision-making in clinical settings, sometimes resulting in unnecessary delays to treatment.Methods: This protocol has been developed using the PRISMA-P guidelines. We will search the main clinical indexing databases (including PubMed/MEDLINE, EMBASE, Cochrane reviews, and ClinicalTrials.gov) for studies that evaluated outcomes in terms of morbidity and mortality among anticoagulated individuals aged over 65, to identify all English language studies published between the years 2000 and 2021. The identified studies will then be screened using pre-determined eligibility criteria detailed in the body of this work. Finally, two independent reviewers will screen, select, evaluate the included studies for quality, and extract data related to the use of anticoagulants in the elderly from all relevant sources. A logically sound analytic framework will then be employed to determine the impact of the use of anticoagulation on outcomes as outlined. Discussion: This study aims to identify the existing evidence for outcomes in this population, contribute to the current body of knowledge, and provide more explicit guidance for clinical practice. We envisage that the findings surrounding outcomes in the head-injured, anticoagulated elderly population will guide clinicians towards better decision-making in both the in-patient and out-patient setting and contribute to the development of clinical guidelines. Systematic review registration: This systematic review is registered on the PROSPERO database with registration number: CRD42021220974

show abstract

Does pre-injury anticoagulation make chest tubes any less safe? A nationwide retrospective analysis

Tarantino,

Wood,

Hancock

et al. 2024

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

The effect of preinjury anticoagulation on mortality in trauma patients: A systematic review and meta-analysis

Cited by 13 publications

References 63 publications

A cost-effectiveness and value of information analysis to inform future research of tranexamic acid for older adults experiencing mild traumatic brain injury

A cost-effectiveness and value of information analysis to inform future research of tranexamic acid for older adults experiencing mild traumatic brain injury

Outcomes in terms of morbidity and mortality among elderly head injury patients on pre-injury anticoagulation: A systematic review protocol

Does pre-injury anticoagulation make chest tubes any less safe? A nationwide retrospective analysis

Contact Info

Product

Resources

About