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Anticoagulation and the elderly head trauma patient.
Ramesh Grandhi1, Therèse M Duane, Tracey Dechert
1Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
The American Surgeon
|September 24, 2008
Summary
Elderly patients on warfarin (anticoagulation therapy) had higher mortality after head injury compared to those not on warfarin. Selective use of anticoagulation in this population is crucial.
Area of Science:
- Trauma Surgery
- Geriatric Medicine
- Pharmacology
Background:
- Anticoagulation therapy is common in elderly patients.
- Head injuries in the elderly can have severe outcomes.
- The impact of anticoagulation on head injury outcomes requires investigation.
Purpose of the Study:
- To determine the effect of anticoagulation therapy on outcomes in elderly patients with closed head injury.
- To compare mortality and morbidity between elderly head injury patients on warfarin versus those not on warfarin.
Main Methods:
- Retrospective review of elderly patients (>= 65 years) with closed head injury.
- Comparison of 52 patients on warfarin (AC) with 439 patients not on warfarin (NAC).
- 1:3 propensity matching was used to create comparable groups for analysis (49 AC vs. 147 NAC).
Main Results:
- The anticoagulation group (AC) had a higher head abbreviated injury score (AIS) on admission.
- After propensity matching, the AC group exhibited a significantly higher mortality rate (38.8% vs. 23.1%, P=0.04).
- Morbidity was greater in the AC group, with similar repeat International Normalized Ratio (INR) values between survivors and non-survivors.
Conclusions:
- Anticoagulation therapy, specifically warfarin, is associated with increased morbidity and mortality in elderly patients with closed head injury.
- Preventing head injuries and judiciously using warfarin in this demographic are essential for reducing mortality.
- Further research into anticoagulation management for elderly head injury patients is warranted.
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