Inappropriate antithrombotic use in geriatric patients with complicated traumatic brain injury.

IF 2.9 2区医学 Q2 CRITICAL CARE MEDICINE

Journal of Trauma and Acute Care Surgery Pub Date : 2025-01-06 DOI:10.1097/TA.0000000000004552

Diwas Gautam, David Botros, Jackson Aubrey, Michael T Bounajem, Sarah Lombardo, Janet Cortez, Marta McCrum, Toby Enniss, Megan Puckett, Christian A Bowers, Sarah T Menacho, Ramesh Grandhi

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Abstract

Background: Preinjury antithrombotic (AT) use is associated with worse outcomes for geriatric (65 years or older) patients with traumatic brain injury (TBI). Previous studies have found that use of AT outside established guidelines is widespread in TBI patients.

Methods: In this single-center retrospective cross-sectional study, we examined inappropriate AT use among geriatric patients presenting with traumatic intracranial hemorrhage. We reviewed records of patients 65 years or older with preinjury AT use who presented to a Level 1 trauma center with traumatic intracranial hemorrhage between 2016 and 2023. Patient demographics and AT indications/types were extracted. Appropriateness of AT use was determined using established guidelines.

Results: The cohort comprised 207 patients (56.5% male; median age, 77 years). Fall was the most common mechanism of injury (87.9%). At initial presentation, 87.0% of patients had mild TBI (Glasgow Coma Scale scores 13-15). The two most common indications for AT use were atrial fibrillation (41.5%) and venous thromboembolism (14.5%). Anticoagulation therapy was used by 51.7% of patients, antiplatelet therapy by 40.1%, and both by 8.2%. Prescribed AT agents included warfarin (23.2%), direct oral anticoagulants (36.2%), aspirin (32.4%), and clopidogrel (15.0%). Per clinical guidelines, 31 patients (15.0%) were determined to be inappropriately on AT therapy. On multivariable analysis, venous thromboembolism (odds ratio [OR], 5.32; 95% confidence interval [CI], 1.80-15.71; p = 0.002) and arterial stent (OR, 4.69; 95% CI, 1.53-14.37; p = 0.007) were associated with inappropriate AT use; aspirin was the most common inappropriately prescribed AT (OR, 3.59; 95% CI, 1.45-8.91; p = 0.006).

Conclusion: Overall, 15% of geriatric TBI patients with preinjury AT use were prescribed this therapy outside of current guidelines. Trauma providers should remain vigilant in identifying such patients and collaborate across multidisciplinary teams to implement interventions that minimize inappropriate AT use.

Level of evidence: Prognostic and Epidemiological Study; Level IV.

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老年复杂外伤性脑损伤患者抗栓药物使用不当。

背景：损伤前抗血栓（AT）使用与老年（65岁或以上）创伤性脑损伤（TBI）患者预后较差相关。先前的研究发现，在既定指南之外使用AT在TBI患者中很普遍。方法：在这项单中心回顾性横断面研究中，我们检查了外伤性颅内出血的老年患者不适当的AT使用。我们回顾了2016年至2023年期间在一级创伤中心就诊的65岁及以上的创伤前AT患者的记录。提取患者人口统计学和AT指征/类型。根据既定指南确定AT使用的适当性。结果：该队列共纳入207例患者(56.5%为男性；中位年龄，77岁)。跌倒是最常见的损伤机制（87.9%）。初次就诊时，87.0%的患者为轻度TBI（格拉斯哥昏迷评分13-15分）。心房颤动（41.5%）和静脉血栓栓塞（14.5%）是使用AT的两个最常见适应症。51.7%的患者使用抗凝治疗，40.1%的患者使用抗血小板治疗，8.2%的患者同时使用抗凝治疗。处方AT药物包括华法林（23.2%）、直接口服抗凝剂（36.2%）、阿司匹林（32.4%）和氯吡格雷（15.0%）。根据临床指南，31例患者（15.0%）被确定不适合AT治疗。在多变量分析中，静脉血栓栓塞(优势比[OR]， 5.32；95%置信区间[CI]， 1.80-15.71；p = 0.002)和动脉支架(OR, 4.69；95% ci, 1.53-14.37；p = 0.007)与AT使用不当相关；阿司匹林是最常见的不适当处方AT (OR, 3.59；95% ci, 1.45-8.91；P = 0.006)。结论：总体而言，15%的老年TBI患者在损伤前使用AT治疗，而不是目前的指南。创伤提供者应保持警惕，识别此类患者，并与多学科团队合作，实施干预措施，最大限度地减少不适当的AT使用。证据水平：预后和流行病学研究；IV级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.