Antithrombotic and risk of hemorrhagic complications in over-60-year-olds after mild-minimal traumatic brain injury

Brain Inj. 2023 Dec 6;37(12-14):1355-1361. doi: 10.1080/02699052.2023.2284907. Epub 2023 Dec 28.

Abstract

Primary objective: to identify if antithombotics are risk factors for intracereral lesion in older adults with minimal-mild traumatic brain injury (m-mTBI).

Research desing: prospective cohort study.

Methods and procedures: We included 2,303 patients over 60 years arriving at our Emergency Department within 24 hours of an mTBI with a Glasgow Coma Scale (GSC) of 14-15. Data were gathered on clinical history, cranial CT scans, blood analyses.

Outcomes and results: 91.1% had an admission GSC score of 15, and 23.6% developed intracranial complications. In bivariate analyses, statins were associated with a 1.28-fold lower risk of IC. Hemorrhagic progression was 29.76-fold higher in patients receiving anticoagulants, with no difference among anticoagulant types. Male sex, GSC of 14, alcohol consumption, and the presence of tumor were risk factors for IC. In multivariate analysis, GSC of 14, alcohol consumption, and malignancy emerged as risk factors for these complications, neurological disease and diabetes as protective factors. After exclusion of neurological disease and diabetes from the multivariate model, a GSC of 14 showed the highest predictive capacity.

Conclusions: Antithrombotics intake are not risks factor for intracranial injury in minimal-mild brain injury trauma. Further research is needed taking account of their fragility and comorbidities.

Keywords: 60 years; Antithrombotics; intracranial complications; minimal-mild traumatic brain injury; risk factors.

MeSH terms

  • Aged
  • Anticoagulants / adverse effects
  • Brain Concussion* / complications
  • Brain Injuries, Traumatic* / complications
  • Craniocerebral Trauma*
  • Diabetes Mellitus*
  • Fibrinolytic Agents
  • Glasgow Coma Scale
  • Humans
  • Male
  • Nervous System Diseases*
  • Prospective Studies

Substances

  • Fibrinolytic Agents
  • Anticoagulants