Risk of Deterioration of Geriatric Traumatic Brain Injury in Patients Treated with Antithrombotic Drugs

• Published in: World neurosurgery 2019-07, Vol.127, p.e1221-e1227
• Main Authors: Suehiro, Eiichi, Fujiyama, Yuichi, Kiyohira, Miwa, Haji, Kouhei, Ishihara, Hideyuki, Nomura, Sadahiro, Suzuki, Michiyasu
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Antithrombotic drugs; Brain Injuries, Traumatic - chemically induced; Brain Injuries, Traumatic - diagnostic imaging; Brain Injuries, Traumatic - drug therapy; Deterioration; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Geriatric traumatic brain injury; Humans; Male; Prospective Studies; Reversal of antithrombotic drugs; Risk Factors; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.04.108

Developed countries have rapidly aging populations and the use of antithrombotic drugs is increasing. We investigated the effects of antithrombotic drugs and reversal of these drugs in patients with geriatric traumatic brain injury (TBI). Age, sex, mechanism of injury, Glasgow Coma Scale on admission, head computed tomography findings, antithrombotic therapy, acute exacerbation, and outcomes at discharge were examined in 711 patients with geriatric TBI, complicated with traumatic intracranial hemorrhage using data from the Japan Neurotrauma Data Bank Project 2015 (JNTDB P2015). These items were compared between patients who did and did not receive antithrombotic therapy. We also conducted a questionnaire survey of reversal of antithrombotic therapy at hospitals participating in the JNTDB P2015. Acute exacerbation was compared in hospitals that did and did not regularly use reversal of this therapy. The major cause of injury was a fall. In head computed tomography, acute subdural hematoma was found in 65.7% of the subjects. Antithrombotic therapy was performed in 30.4% of subjects, and these subjects were significantly older than those who did not receive this therapy; many had a fall as the mechanism of injury, and the level of consciousness was significantly exacerbated with this therapy. In hospitals that performed regular reversal, late exacerbation of the level of consciousness was suppressed. Patients with geriatric TBI who are given antithrombotic drugs have a risk for late exacerbation, even if initially diagnosed with mild TBI. Therefore, there is a possibility that reversal of antithrombotic drugs is important to suppress the risk of deterioration of patients with TBI.