Decreasing Trends of Traumatic Brain Injury Despite a Surge in Anticoagulant Use in the Elderly

In recent years, with the introduction of new anticoagulants there has been a rise in their usage among elderly population who are at risk for traumatic brain injury (TBI) at the same time. We assessed the change in use of anticoagulant in elderly trauma patients and its association with TBI outcomes.

We performed a 5-y retrospective analysis of Trauma Quality Improvement Program (2017-2021) of trauma patients ≥65 y. Patient who had TBI were identified. We queried the preexisting comorbid conditions for anticoagulant use. The primary outcome was mortality, and the secondary outcome was TBI admissions during study period. We conducted a linear regression analysis to assess for trends in data. We also utilized a propensity score matching in 1:1 ratio to compare patients on prehospital anticoagulant versus nonreceivers.

A total of 1,688,157 patients were included. The trend of TBI admission over the study period has been decreasing significantly (P < 0.001). Prehospital anticoagulant use has been increasing over the study period with the slope of 0.078 (P = 0.043). After propensity score matching, patients with TBI who used anticoagulants before hospitalization had a higher mortality rate compared to nonreceivers (9.1% versus 6.8%, P < 0.001). The mortality rate in patients with anticoagulant use decreased from 2017 to 2019 and increased from 2019 to 2021. However this change was not significant in a linear fashion.

Despite increasing trends of anticoagulant usage, which is associated with a higher mortality risk after TBI in elderly, the rate of TBI admissions has been decreasing over the years. Meanwhile, the trend of mortality in patients with anticoagulant use appears to remain unchanged.