Impact of age and anticoagulation: need for neurosurgical intervention in trauma patients with mild traumatic brain injury

J Trauma Acute Care Surg. 2012 Jul;73(1):126-30. doi: 10.1097/TA.0b013e31824b01af.


Background: Of the 500,000 brain injuries in the United States annually, 80% are considered mild (mild traumatic brain injury). Unfortunately, 2% to 3% of them will subsequently deteriorate and result in severe neurologic dysfunction. Intracerebral changes in the elderly, chronic oral anticoagulation, and platelet inhibition may contribute to the development of intracranial bleeding after minor head injury. We sought to investigate the association of age and the use of anticoagulation and antiplatelet therapy with neurologic deterioration and the need for neurosurgical intervention in patients presenting with mild traumatic brain injury.

Methods: A retrospective review of all adult (>14 years) patients admitted to our Level I trauma service with a Glasgow Coma Scale (GCS) score of 14 to 15 who underwent neurosurgical intervention during their hospital stay was performed. Patients were stratified into two groups, age <65 years and age ≥ 65 years. Each group was then further stratified by the use of anticoagulants: warfarin, aspirin, clopidogrel, or a combination. Mechanism of injury, prehospital complaints, admission GCS, type of neurosurgical intervention, intensive care unit length of stay, hospital length of stay, and discharge disposition were evaluated. Z test and logistic regression were used to compare proportions or percentages from different groups.

Results: Of the 7,678 patients evaluated during the study period, 101 (1.3%) required neurosurgical intervention. The ≥ 65 years population underwent significantly more interventions as did those patients on anticoagulants.

Conclusion: All patients aged 65 years or older who present with a GCS score of >13 after head trauma should undergo a screening computed tomography of the head regardless of prehospital use of anticoagulation. Patients younger than 65 years can be selectively screened based on presenting complaints and mechanism of injury provided they are not on anticoagulation.

MeSH terms

  • Age Factors
  • Aged
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Aspirin / adverse effects
  • Aspirin / therapeutic use
  • Brain Injuries / complications
  • Brain Injuries / diagnostic imaging
  • Brain Injuries / surgery*
  • Clopidogrel
  • Craniotomy
  • Decompressive Craniectomy
  • Glasgow Coma Scale
  • Humans
  • Intracranial Hemorrhages / chemically induced
  • Intracranial Hemorrhages / diagnostic imaging
  • Intracranial Hemorrhages / etiology
  • Middle Aged
  • Retrospective Studies
  • Ticlopidine / adverse effects
  • Ticlopidine / analogs & derivatives
  • Ticlopidine / therapeutic use
  • Time Factors
  • Tomography, X-Ray Computed
  • Warfarin / adverse effects
  • Warfarin / therapeutic use


  • Anticoagulants
  • Warfarin
  • Clopidogrel
  • Ticlopidine
  • Aspirin