Resident Oregon Health & Science University Portland, Oregon, United States
Introduction: Impaired coagulation is a known risk factor for adverse outcomes in traumatic brain injury (TBI). Reversal of anticoagulants is commonly employed to mitigate this risk, but the effect of reversal of antiplatelets on outcomes is less clear. The benefit of early reversal is presumed, but a time-response relationship is not well established. These decisions are largely provider- and system-dependent, which provides a natural experiment to examine their effects on TBI outcomes.
Methods: This is a retrospective analysis of prospectively collected TBI admissions at a single institution from 2013-2020. Patients with anticoagulant/antiplatelet medication use were selected, stratified by type of medication, reversal agents employed, and early vs late reversal (defined greater/less than 2 hours from diagnosis of TBI). Multivariate logistic regression was used to examine the relationship of these factors with a composite outcome of radiographic progression of TBI, neurological deterioration, and need for neurosurgical intervention.
Results: Analysis included 474 patients. The most common medications were aspirin (73.2%) and coumadin (21.1%). Patients on anticoagulation received reversal in 83.6% of cases, versus 20.3% for aspirin and 39.1% for other antiplatelets. Patients on anticoagulation were significantly more likely to experience radiographic progression or need neurosurgical intervention than patients on antiplatelets. Multivariate logistic regression revealed that patients who received reversal were significantly more likely to experience the composite outcome (OR 8.15, CI 4.26-15.61). Reversal administration > 2 hours from presentation did not confer any additional risk in these patients (OR 1.25, CI 0.59-2.66).
Conclusion : TBI patients on anticoagulation were more likely to receive reversal but appear to be at higher risk for radiographic progression and intervention than those on antiplatelet medications. Patients who received reversal had increased odds of adverse outcomes. Further study is needed to determine an optimum reversal algorithm for TBI patients.
