Therapeutic anticoagulation in patients with traumatic brain injury

• Published in: The Journal of surgical research 2016-09, Vol.205 (1), p.186-191
• Main Authors: Matsushima, Kazuhide, MD, Inaba, Kenji, MD, Cho, Jayun, MD, Mohammed, Hussan, MD, Herr, Keith, MD, Leichtle, Stefan, MD, Zada, Gabriel, MD, Demetriades, Demetrios, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anticoagulants - therapeutic use; Brain Hemorrhage, Traumatic - complications; Brain Injuries, Traumatic - complications; Disease Progression; Female; Humans; Male; Middle Aged; Outcome; Retrospective Studies; Safety; Surgery; Therapeutic anticoagulation; Traumatic brain injury; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.06.042

Abstract Background Therapeutic anticoagulation (TAC) is often required in trauma patients for various indications. However, it remains unknown whether TAC can be safely initiated in the post-injury period for patients with traumatic brain injury (TBI). The purpose of this study was to evaluate the safety of TAC in TBI patients. Materials and methods We conducted a 7-year retrospective study. All TBI patients who received TAC within 60 days post-injury were included. In addition to patient and injury characteristics, detailed information regarding TAC was collected. The primary outcome was the incidence of neurological deterioration or progression of hemorrhagic TBI on repeat head computed tomography (CT) after initiation of TAC. Univariate and multivariate analyses were used to identify factors associated with progression of hemorrhagic TBI after TAC. Results A total of 3,355 TBI patients were identified. Of those, 72 patients (2.1%) received TAC. Median age: 59, 76.4% male, median ISS: 19, median admission Glasgow Coma Scale: 14, median Rotterdam score on the initial head CT: 3. While atrial fibrillation was the most common pre-injury indication for TAC, venous thromboembolism was the most common post-injury indication. The median post-injury time of initiation of TAC was 9 days. Intravenous heparin infusion was most commonly used agent for TAC (70.8%). None of our study patients developed any signs of neurological deterioration due to TAC. Progression of hemorrhagic TBI on repeat head CT was observed in 6 patients. In a multiple logistic regression model, age ≥65 years was significantly associated with progression of hemorrhagic TBI after TAC (OR: 15.2, 95% CI: 1.1-212.7, p=0.04). Conclusions This study shows preliminary data regarding TAC initiated in patients with TBI. Further prospective study is warranted to determine the risks and benefits of TAC in this specific group of patients.