Not all traumatic brain injury patients on preinjury anticoagulation are the same

Sai Krishna Bhogadi; Qaidar Alizai; Christina Colosimo; Audrey L Spencer; Collin Stewart; Adam Nelson; Michael Ditillo; Lourdes Castanon; Louis J Magnotti; Bellal Joseph; BIG Multi-institutional Study Group; American Association for the Surgery of Trauma Brain Injury Guidelines Multi-institutional Study Group; Linda Dultz; George Black; Marc Campbell; Allison E Berndtson; Todd Costantini; Andrew Kerwin; David Skarupa; Sigrid Burruss; Lauren Delgado; Mario Gomez; Dalier R Mederos; Robert Winfield; Daniel Cullinane; Hamidreza Hosseinpour

doi:10.1016/j.amjsurg.2023.05.034

Not all traumatic brain injury patients on preinjury anticoagulation are the same

Am J Surg. 2023 Dec;226(6):785-789. doi: 10.1016/j.amjsurg.2023.05.034. Epub 2023 Jun 3.

Authors

Sai Krishna Bhogadi¹, Qaidar Alizai², Christina Colosimo³, Audrey L Spencer⁴, Collin Stewart⁵, Adam Nelson⁶, Michael Ditillo⁷, Lourdes Castanon⁸, Louis J Magnotti⁹, Bellal Joseph¹⁰; BIG Multi-institutional Study Group¹¹; American Association for the Surgery of Trauma Brain Injury Guidelines Multi-institutional Study Group¹¹; Linda Dultz¹¹, George Black¹¹, Marc Campbell¹¹, Allison E Berndtson¹¹, Todd Costantini¹¹, Andrew Kerwin¹¹, David Skarupa¹¹, Sigrid Burruss¹¹, Lauren Delgado¹¹, Mario Gomez¹¹, Dalier R Mederos¹¹, Robert Winfield¹¹, Daniel Cullinane¹¹, Hamidreza Hosseinpour¹¹

Affiliations

¹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: saikbhogadi@arizona.edu.
² Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: qaidaralizai@arizona.edu.
³ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: ccolosim@arizona.edu.
⁴ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: audreylspencer@arizona.edu.
⁵ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: chstewart@surgery.arizona.edu.
⁶ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: adamcnelson@arizona.edu.
⁷ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: mfditillo@arizona.edu.
⁸ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: lourdescastanon@surgery.arizona.edu.
⁹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: lmagnotti@arizona.edu.
¹⁰ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: bjoseph@arizona.edu.
¹¹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.

PMID: 37301645
DOI: 10.1016/j.amjsurg.2023.05.034

Abstract

Background: Prognostic significance of different anticoagulants in TBI patients remains unanswered. We aimed to compare effects of different anticoagulants on outcomes of TBI patients.

Methods: A secondary analysis of AAST BIG MIT. Blunt TBI patients ≥50 years using anticoagulants presenting ICH were identified. Outcomes were progression of ICH and need for neurosurgical intervention (NSI).

Results: 393 patients were identified. Mean age was 74 and most common anticoagulant was aspirin (30%), followed by Plavix (28%), and coumadin (20%). 20% had progression of ICH and 10% underwent NSI. On multivariate regression for ICH progression, warfarin, SDH, IPH, SAH, alcohol intoxication and neurologic exam deterioration were associated with increased odds. Warfarin, abnormal neurologic exam on presentation, and SDH were independent predictors of NSI.

Conclusions: Our findings reflect a dynamic interaction between type of anticoagulants, bleeding pattern & outcomes. Future modifications of BIG may need to take the type of anticoagulant into consideration.

MeSH terms

Aged
Anticoagulants / adverse effects
Aspirin / adverse effects
Brain Injuries, Traumatic*
Humans
Retrospective Studies
Warfarin* / adverse effects

Substances

Warfarin
Anticoagulants
Aspirin