Outcomes following traumatic brain injury in patients with Pre-Injury antiplatelets versus anticoagulants: A systematic review and Meta-Analysis.

Management of traumatic brain injury (TBI) patients on pre-TBI antithrombotic medications poses a clinical challenge in everyday practice. However, the safety profiles of antiplatelets (APs) have not been systematically studied and compared to anticoagulants (ACs) in this patient population. In this PRISMA-compliant systematic review the EMBASE and MEDLINE databases were systematically queried to identify comparative studies in patients with TBI and pre-injury AP and AC medications. Meta-analysis with random effect models were conducted for all outcomes. Forest plots were utilized to visually represent each study's effect and pooled estimates. Intracranial hemorrhage rates were statistically significantly higher for patients on single AP vs. AC (AP 19.7%; AC 9.3%; OR 1.35; CI 1.02-1.78; I² 49%, P = 0.03). Cumulative mortality rates (AP 6%; AC 2.5%; OR 0.72; CI; 0.39-1.32 I² 55%, P = 0.3), worsening ICH rates (AP 0.3%; AC 0.4%; OR 0.85; CI 0.16-4.55; I² 0%, P = 0.8) and need for neurosurgical intervention (AP 2.6%; AC 0.9%; OR 1.27; CI 0.48-3.39; I² 68%, P = 0.6) were comparable. For elderly patients (> 65 years old), ICH rates were comparable between groups (AP 46.8%; AC 28.3%; OR 1.03; CI 0.57-1.85; I² 66%, P = 0.9) and mortality was statistically significantly lower in the AP group (AP 19.4%; AC 29.5%; OR 0.46; CI 0.31-0.69; I² 0%, P < 0.001). Single pre-TBI AP carries more risk for ICH compared to AC. Mortality risk, worsening ICH risk and need for neurosurgical intervention are comparable. For elderly patients, ICH rates were comparable, but APs were associated with lower mortality.