J Korean Neurosurg Soc.  2015 Sep;58(3):262-270. 10.3340/jkns.2015.58.3.262.

Clinical Factors and Perioperative Strategies Associated with Outcome in Preinjury Antiplatelet and Anticoagulation Therapy for Patients with Traumatic Brain Injuries

• Pang CH
• Lee SE
• Yoo H

• KMID: 2191381
• DOI: http://doi.org/10.3340/jkns.2015.58.3.262

Abstract

OBJECTIVE
Long-term oral anticoagulation or antiplatelet therapy has been used with increasing frequency in the elderly. These patients are at increased risk of morbidity and mortality from expansion of intracranial hemorrhage. We conducted a single-center retrospective case control study to evaluate risk factors associated with outcomes and to identify the differences in outcome in traumatic brain injury between preinjury anticoagulation use and without anticoagulation.
METHODS
A retrospective study of patients who underwent craniotomy or craniectomy for acute traumatic cerebral hemorrhage, between January 2005 and December 2014 was performed.
RESULTS
A consecutive series of 50 patients were evaluated. The factors significantly differed between the two groups were initial Prothrombin Time-International Normalized Ratio, initial platelet count, initial Glasgow Coma Scale score, and postoperative intracranial bleeding. Mean Glasgow Outcome Scale (GOS) score were similar between the two groups. In the patient with low-energy trauma only, no significant differences in GOS score, postoperative bleeding and many other factors were observed. The contributing factors to postoperative bleeding was preinjury anticoagulation and its adjusted odds ratio was 12 [adjusted odds ratio (OR), 12.242; p=0.0070]. The contributing factors to low GOS scores, which mean unfavorable neurological outcomes, were age (adjusted OR, 1.073; p=0.039) and Rotterdam scale score for CT scans (adjusted OR, 3.123; p=0.0020).
CONCLUSION
Preinjury anticoagulation therapy contributed significantly to the occurrence of postoperative bleeding. However, preinjury anticoagulation therapy in the patients with low-energy trauma did not contribute to the poor clinical outcomes or total hospital stay. Careful attention should be given to older patients and severity of hemorrhage on initial brain CT.

Keyword

Traumatic brain injury; Antiplatelet therapy; Anticoagulation therapy

MeSH Terms

Aged
Brain
Brain Injuries*
Case-Control Studies
Cerebral Hemorrhage, Traumatic
Craniotomy
Glasgow Coma Scale
Glasgow Outcome Scale
Hemorrhage
Humans
Intracranial Hemorrhages
Length of Stay
Mortality
Odds Ratio
Platelet Count
Prothrombin
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
Prothrombin

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