Preinjury Antithrombotic Use in Patients With Traumatic Brain Injury Varies by Level of Trauma Center

The use of antiplatelet and anticoagulant medications is increasingly common and complicates treatment after traumatic brain injury. Population demographics and resource availability, specifically access to platelet function assays and antiplatelet and anticoagulant reversal strategies, differ among trauma centers. In this study, we aimed to describe the differences in the antiplatelet and anticoagulant status and interventions received for patients with traumatic brain injury between level I and level III trauma centers.

Retrospective review of patients diagnosed with traumatic brain injury from January through December 2022 was completed, including patients from level I and level III trauma centers within the same health system. Univariate analyses were then performed examining patient demographic information, anticoagulant and antiplatelet status, and rates of reversal agents administered and neurosurgical interventions received.

A total of 531 patients were included. Patients who arrived to our level III trauma center compared to level I trauma center via scene admission were more likely to be older (75 versus 54 ys) and on antiplatelet (42 versus 22%) and anticoagulant (21 versus 9%) agents, and subsequently their care more often included anticoagulant reversal (10 versus 2%) (P < 0.05). These findings were replicated when looking at the level I trauma center scene arrival versus transfer cohorts.

The populations served by lower-level trauma centers continue to age, and the care of traumatic brain injury is further complicated by preinjury anticoagulant and antiplatelet use. Trauma centers need to continually adapt to ensure they are equipped with the necessary resources required to provide their patients with optimal care.