Abstract | BACKGROUND:
Traumatic brain injury (TBI) is a common injury and constitutes up to 3% of emergency department (ED) visits. Current studies show that TBI is most commonly inflicted in older patients after ground-level falls. These patients often take medications affecting coagulation such as anticoagulants or antiplatelet drugs. Guidelines for ED TBI-management assume that anticoagulation therapy (ACT) confers a higher risk of traumatic intracranial hemorrhage (TICH) than antiplatelet therapy ( APT). However, recent studies have challenged this. This study aimed to evaluate if oral anticoagulation and platelet inhibitors affected rate of TICH in head-trauma patients with ground-level falls. METHODS: This was a retrospective review of medical records during January 1, 2017 to December 31, 2017 and January 1 2020 to December 31, 2020 of all patients seeking ED care because of head-trauma. Patients ≥ 18 years with ground-level falls were included. RESULTS: The study included 1938 head-trauma patients with ground-level falls. Median age of patients with TICH was 81 years. The RR for TICH in APT-patients compared to patients without medication affecting coagulation was 1.72 (p = 0.01) (95% Confidence Interval (CI) 1.13-2.60) and 1.08 (p = 0.73), (95% CI 0.70-1.67) in ACT-patients. APT was independently associated with TICH in regression analysis (OR 1.59 (95% CI 1.02-2.49), p = 0.041). CONCLUSION: This study adds to the growing evidence that APT-patients with ground-level falls might have as high or higher risk of TICH than ACT-patients. This is not addressed in the current guidelines which may need to be updated. We therefore recommend broad prospective studies.
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Authors | Tomas Vedin, Jakob Lundager Forberg, Ebba Anefjäll, Riikka Lehtinen, Mohammed Faisal, Marcus Edelhamre |
Journal | European journal of trauma and emergency surgery : official publication of the European Trauma Society
(Eur J Trauma Emerg Surg)
Vol. 48
Issue 6
Pg. 4909-4917
(Dec 2022)
ISSN: 1863-9941 [Electronic] Germany |
PMID | 35732809
(Publication Type: Journal Article)
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Copyright | © 2022. The Author(s). |
Chemical References |
- Platelet Aggregation Inhibitors
- APT
- Anticoagulants
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Topics |
- Humans
- Aged
- Aged, 80 and over
- Platelet Aggregation Inhibitors
(therapeutic use)
- Retrospective Studies
- Prospective Studies
- Intracranial Hemorrhage, Traumatic
(therapy)
- Anticoagulants
(therapeutic use)
- Craniocerebral Trauma
(complications)
- Brain Injuries, Traumatic
(complications, drug therapy)
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