Key result
Resuming anticoagulation or antiplatelet therapy between 7 and 14 days after traumatic brain injury was associated with a 10% mortality rate, compared to 68.8% in patients who never resumed therapy.
Why the study?
Does the timing of resuming oral anticoagulation/antiplatelet therapy affect mortality and adverse events in patients with traumatic brain injury?
Cohort (n=85)
No
Does the timing of resuming oral anticoagulation/antiplatelet therapy affect mortality and adverse events in patients with traumatic brain injury?
Absolute Event Rate: 10% vs 68.8%
In patients with traumatic brain injury on prior anti-clotting agents, resuming therapy between 7 and 14 days may minimize adverse events, though larger prospective studies are needed to establish definitive protocols.
OBJECTIVE: There is no standard protocol to guide the optimal time to resume anti-clotting agents after traumatic brain injury (TBI) in patients with a continued indication for anticoagulation/antiplatelet therapy (AAT). This study develops baseline data supporting a future prospective cohort study. We predict that there will be significantly decreased adverse events when AAT is started on or after Day 7. METHODS: A retrospective chart review of 256 patients was performed. Patients admitted to a level I trauma center in West Texas between January 1, 2009, and December 31, 2012, on anti-clotting agents (specifically acetylsalicylic acid, coumadin, and/or clopidogrel) and who suffered a TBI were included. Patient metrics included admission coagulation studies, type of TBI and treatment, and time to continuation of AAT. Outcomes were assessed using follow-up appointment data. The primary outcome was death (mortality). Secondary outcomes included myocardial infarction, stroke, re-bleed, venous thromboembolism, and pneumonia. RESULTS: A total of 256 patients met the inclusion criteria. However, only 85 patients on AAT presented for the six-month follow-up. Time to AAT resumption varied from immediate to 31 days. Out of the 85 patients, 32 patients never resumed AAT, 32 patients were restarted on AAT medication in less than seven days, 10 patients restarted medication between seven and 14 days, and 11 patients restarted AAT in more than 14 days. Adverse events occurred most infrequently in the AAT group resuming therapy between seven and 14 days (10%). Adverse events were most prevalent in the AAT group that never resumed therapy (68.8%). CONCLUSION: While most studies suggest that the safest time for resuming AAT lies between three and 10 days, our study revealed that adverse events were minimized in patients on AAT between seven and 9.5 days.
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Puckett et al. (2018) conducted a cohort in Traumatic brain injury in patients on prior anticoagulation/antiplatelet therapy (n=85). Resumption of anticoagulation/antiplatelet therapy (AAT) between 7 and 14 days vs. Never resumed AAT was evaluated on Death (mortality). Resuming anticoagulation or antiplatelet therapy between 7 and 14 days after traumatic brain injury was associated with a 10% mortality rate, compared to 68.8% in patients who never resumed therapy.
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