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Updated: Jun 3, 2025
Author Spotlight: Deciphering Coagulation Disorders in Traumatic Brain Injury Patients
Published on: August 4, 2023
Inappropriate antithrombotic use in geriatric patients with complicated traumatic brain injury
Diwas Gautam1, David Botros, Jackson Aubrey
1From the Spencer Fox Eccles School of Medicine (D.G., J.A.), Department of Neurosurgery (D.B., M.T.B., S.T.M., R.G.), Department of Surgery (S.L., J.C., M.M., T.E.), Division of Geriatrics and Department of Internal Medicine (M.P.), University of Utah, Salt Lake City, Utah; and Bowers Neurosurgical Frailty and Outcomes Data Science Lab (C.A.B.), Flint, Michigan.
Background:
Preinjury antithrombotic (AT) use is associated with worse outcomes for geriatric (65 years or older) patients with traumatic brain injury (TBI). Previous studies have found that use of AT outside established guidelines is widespread in TBI patients.
Methods:
In this single-center retrospective cross-sectional study, we examined inappropriate AT use among geriatric patients presenting with traumatic intracranial hemorrhage. We reviewed records of patients 65 years or older with preinjury AT use who presented to a Level 1 trauma center with traumatic intracranial hemorrhage between 2016 and 2023. Patient demographics and AT indications/types were extracted. Appropriateness of AT use was determined using established guidelines.
Results:
The cohort comprised 207 patients (56.5% male; median age, 77 years). Fall was the most common mechanism of injury (87.9%). At initial presentation, 87.0% of patients had mild TBI (Glasgow Coma Scale scores 13-15). The two most common indications for AT use were atrial fibrillation (41.5%) and venous thromboembolism (14.5%). Anticoagulation therapy was used by 51.7% of patients, antiplatelet therapy by 40.1%, and both by 8.2%. Prescribed AT agents included warfarin (23.2%), direct oral anticoagulants (36.2%), aspirin (32.4%), and clopidogrel (15.0%). Per clinical guidelines, 31 patients (15.0%) were determined to be inappropriately on AT therapy. On multivariable analysis, venous thromboembolism (odds ratio [OR], 5.32; 95% confidence interval [CI], 1.80-15.71; p = 0.002) and arterial stent (OR, 4.69; 95% CI, 1.53-14.37; p = 0.007) were associated with inappropriate AT use; aspirin was the most common inappropriately prescribed AT (OR, 3.59; 95% CI, 1.45-8.91; p = 0.006).
Conclusion:
Overall, 15% of geriatric TBI patients with preinjury AT use were prescribed this therapy outside of current guidelines. Trauma providers should remain vigilant in identifying such patients and collaborate across multidisciplinary teams to implement interventions that minimize inappropriate AT use.
Level Of Evidence:
Prognostic and Epidemiological; Level IV.
