Key result
Inappropriate antithrombotic therapy affects 10% of TBI patients, linked to indication, age, and female sex.
Why the study?
Preinjury inappropriate antithrombotic therapy offers no benefit and increases intracranial hemorrhage risk and worse outcomes in traumatic brain injury, but its prevalence and predictors were unknown.
What is the prevalence and what are the predictors of inappropriate antithrombotic therapy in patients presenting with traumatic brain injury?
Observational (n=141)
No
What is the prevalence and what are the predictors of inappropriate antithrombotic therapy in patients presenting with traumatic brain injury?
Approximately 10% of patients presenting with traumatic brain injury on preinjury antithrombotic therapy were prescribed it inappropriately, highlighting a need for better medication review.
Answers are grounded in this paper and cite their sources.
May prompt antithrombotic review in older females with TBI; leaves open whether interventions improve outcomes.
BACKGROUND AND OBJECTIVES: A growing proportion of the US population is on antithrombotic therapy (AT), most significantly within the older subpopulation. Decision to use AT is a balance between the intended benefits and known bleeding risk, especially after traumatic brain injury (TBI). Preinjury inappropriate AT offers no benefit for the patient and also increases the risk of intracranial hemorrhage and worse outcome in the setting of TBI. Our objective was to examine the prevalence and predictors of inappropriate AT among patients presenting with TBI to a Level-1 Trauma Center. METHODS: A retrospective chart review was performed on all patients with TBI and preinjury AT who presented to our institution between January 2016 and September 2020. Demographic and clinical data were collected. Appropriateness of AT was determined through established clinical guidelines. Clinical predictors were determined by logistic regression. RESULTS: Of 141 included patients, 41.8% were female (n = 59) and the average age (mean ± SD) was 80.6 ± 9.9. The prescribed antithrombotic agents included aspirin (25.5%, n = 36), clopidogrel (22.7%, n = 32), warfarin (46.8%, n = 66), dabigatran (2.1%, n = 3), rivaroxaban (Janssen) (10.6%, n = 15), and apixaban (Bristol-Myers Squibb Co.) (18.4%, n = 26). The indications for AT were atrial fibrillation (66.7%, n = 94), venous thromboembolism (13.4%, n = 19), cardiac stent (8.5%, n = 12), and myocardial infarction/residual coronary disease (11.3%, n = 16). Inappropriate antithrombotic therapy use varied significantly by antithrombotic indication ( P < .001) with the highest rates seen with venous thromboembolism. Predictive factors also include age ( P = .005) with higher rates younger than 65 years and older than 85 years and female sex ( P = .049). Race and antithrombotic agent were not significant predictors. CONCLUSION: Overall, 1 in 10 patients presenting with TBI were found to be on inappropriate AT. Our study is the first to describe this problem and warrants investigation into possible workflow interventions to prevent post-TBI continuation of inappropriate AT.
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Blitz et al. (2023) conducted an observational in Traumatic Brain Injury (n=141). Inappropriate antithrombotic therapy was evaluated on Prevalence of inappropriate antithrombotic therapy. Inappropriate antithrombotic therapy was identified in 10% of patients presenting with traumatic brain injury, with indication, age, and female sex serving as significant predictors.
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