Anticoagulation therapy in patients with traumatic brain injury: An Eastern Association for the Surgery of Trauma multicenter prospective study

• Published in: Surgery Vol. 169; no. 2; pp. 470 - 476
• Main Authors: Matsushima, Kazuhide, Leichtle, Stefan W., Wild, Jeffrey, Young, Katelyn, Chang, Grace, Demetriades, Demetrios, Lomangino, Cara Diaz, Massetti, Jennifer, Glass, Nina E., Livingston, David H., O’Bosky, Karen, Chan, Julie L., Cullinane, Daniel C., Rippey, Kelly A., Sharma, Jyoti, Nahmias, Jeffry, Grigorian, Areg, Allen, Steven, Armen, Scott B., Berne, John D., Mederos, Dalier, Pascual, Jose L., Resnick, Shelby, Bholat, Omar, Ostry, Lauren, Garcia, Luis J., Vecchio, Rafael Ramos, Winston, Eleanor S., Sabour, Andrew F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2021
• Subjects: Adult; Aged; Anticoagulants - adverse effects; Atrial Fibrillation - drug therapy; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - surgery; Craniotomy - adverse effects; Disease Progression; Female; Hemorrhage - etiology; Hemorrhage - prevention & control; Humans; Male; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Postoperative Period; Preoperative Period; Prospective Studies; Thromboembolism - etiology; Thromboembolism - prevention & control; Time Factors; Time-to-Treatment - statistics & numerical data; United States; Venous Thromboembolism - drug therapy; United States
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2020.07.040

Trauma care providers often face a dilemma regarding anticoagulation therapy initiation in patients with traumatic brain injury owing to the associated risks of traumatic brain injury progression. The aims of this study were the following: (1) to describe the current practice of anticoagulation therapy in traumatic brain injury patients and their outcomes and (2) to identify factors associated with the progression of traumatic brain injury after anticoagulation therapy. In this multicenter prospective observational study, we included computed tomography–proven traumatic brain injury patients who received anticoagulation therapy within 30 days of hospital admission. Our primary outcome was the incidence of clinically significant progression of traumatic brain injury after anticoagulation therapy initiation. A total of 168 patients were enrolled more than 22 months. Atrial fibrillation and venous thromboembolism were the most common pre-injury and postinjury anticoagulation therapy indications, respectively. Overall, 16 patients (9.6%) experienced clinically significant traumatic brain injury progression after anticoagulation therapy, out of which 9 (5.4%) patients subsequently required neurosurgical interventions. Between patients with clinical progression of traumatic brain injury and patients who showed no such progression, there were no significant differences in the baseline demographics and severity of traumatic brain injury. However, anticoagulation therapy was initiated significantly earlier in patients of the deterioration group than those of the no-deterioration group (4.5 days vs 11 days, P = .015). In a multiple logistic regression model, patients who received anticoagulation therapy later after injury had significantly lower risk of clinically significant traumatic brain injury progression (odds ratio: 0.915 for each day, 95% confidence interval: 0.841–0.995, P = .037). Our results suggest that early anticoagulation therapy is associated with higher risk of traumatic brain injury progression, thus a balance between bleeding and thromboembolic risks should be carefully evaluated in each case before initiating anticoagulation therapy.