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Age is not associated with intracranial haemorrhage in patients with mild traumatic brain injury and oral anticoagulation.

Sauter TC, Ziegenhorn S, Ahmad SS, Hautz WE, Ricklin ME, Leichtle AB, Fiedler GM, Haider DG, Exadaktylos AK - J Negat Results Biomed (2016)

Bottom Line: There was no significant difference in age between the patient groups with (n = 86) and without (n = 114) intracranial haemorrhage (p = 0.078).In univariate logistic regression, GCS (OR = 0.419 (0.258; 0.680)) and thromboembolic event as reason for anticoagulant therapy (OR = 0.486 (0.257; 0.918)) were significantly associated with intracranial haemorrhage in patients with mild TBI and anticoagulation (all p < 0.05).Our study found no association between age and intracranial bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland. thomas.sauter@insel.ch.

ABSTRACT

Background: Patients admitted to emergency departments with traumatic brain injury (TBI) are commonly being treated with oral anticoagulants. In contrast to patients without anticoagulant medication, no guidelines, scores or recommendations exist for the management of mild traumatic brain injury in these patients. We therefore tested whether age as one of the high risk factors of the Canadian head CT rule is applicable to a patient population on oral anticoagulants.

Methods: This cross-sectional analysis included all patients with mild TBI and concomitant oral anticoagulant therapy admitted to the Emergency Department, Inselspital Bern, Switzerland, from November 2009 to October 2014 (n = 200). Using a logistic regression model, two groups of patients with mild TBI on oral anticoagulant therapy were compared - those with and those without intracranial haemorrhage.

Results: There was no significant difference in age between the patient groups with (n = 86) and without (n = 114) intracranial haemorrhage (p = 0.078). In univariate logistic regression, GCS (OR = 0.419 (0.258; 0.680)) and thromboembolic event as reason for anticoagulant therapy (OR = 0.486 (0.257; 0.918)) were significantly associated with intracranial haemorrhage in patients with mild TBI and anticoagulation (all p < 0.05). However, there was no association with age (p = 0.078, OR = 1.024 (0.997; 1.051)), the type of accident or additional medication with acetylsalicylic acid or clopidogrel ((both p > 0.05; 0.552 (0.139; 2.202) and 0.256 (0.029; 2.237), respectively).

Conclusion: Our study found no association between age and intracranial bleeding. Therefore, until further risk factors are identified, diagnostic imaging with CCT remains necessary for mild TBI patients on oral anticoagulation of all ages, especially those with therapeutic anticoagulation because of thromboembolic events.

No MeSH data available.


Related in: MedlinePlus

Patient assignment to the different subgroups of TBI
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Fig1: Patient assignment to the different subgroups of TBI

Mentions: The numbers of our patients with traumatic brain injury and mild TBI (defined as GCS 13–15, n = 200), moderate TBI (GCS 9–12, n = 25) and severe TBI (GCS <9, n = 26) and also the number of patients with and without intracranial haemorrhage (ICH) are shown in Fig. 1. Overall, 8 (3.1 %) patients were on clopidogrel and 16 (6.2 %) patients on acetylsalicylic acid in combination with OAC therapy (Table 1). Table 1 lists the reasons for oral anticoagulation in patients with TBI.Fig. 1


Age is not associated with intracranial haemorrhage in patients with mild traumatic brain injury and oral anticoagulation.

Sauter TC, Ziegenhorn S, Ahmad SS, Hautz WE, Ricklin ME, Leichtle AB, Fiedler GM, Haider DG, Exadaktylos AK - J Negat Results Biomed (2016)

Patient assignment to the different subgroups of TBI
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940966&req=5

Fig1: Patient assignment to the different subgroups of TBI
Mentions: The numbers of our patients with traumatic brain injury and mild TBI (defined as GCS 13–15, n = 200), moderate TBI (GCS 9–12, n = 25) and severe TBI (GCS <9, n = 26) and also the number of patients with and without intracranial haemorrhage (ICH) are shown in Fig. 1. Overall, 8 (3.1 %) patients were on clopidogrel and 16 (6.2 %) patients on acetylsalicylic acid in combination with OAC therapy (Table 1). Table 1 lists the reasons for oral anticoagulation in patients with TBI.Fig. 1

Bottom Line: There was no significant difference in age between the patient groups with (n = 86) and without (n = 114) intracranial haemorrhage (p = 0.078).In univariate logistic regression, GCS (OR = 0.419 (0.258; 0.680)) and thromboembolic event as reason for anticoagulant therapy (OR = 0.486 (0.257; 0.918)) were significantly associated with intracranial haemorrhage in patients with mild TBI and anticoagulation (all p < 0.05).Our study found no association between age and intracranial bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland. thomas.sauter@insel.ch.

ABSTRACT

Background: Patients admitted to emergency departments with traumatic brain injury (TBI) are commonly being treated with oral anticoagulants. In contrast to patients without anticoagulant medication, no guidelines, scores or recommendations exist for the management of mild traumatic brain injury in these patients. We therefore tested whether age as one of the high risk factors of the Canadian head CT rule is applicable to a patient population on oral anticoagulants.

Methods: This cross-sectional analysis included all patients with mild TBI and concomitant oral anticoagulant therapy admitted to the Emergency Department, Inselspital Bern, Switzerland, from November 2009 to October 2014 (n = 200). Using a logistic regression model, two groups of patients with mild TBI on oral anticoagulant therapy were compared - those with and those without intracranial haemorrhage.

Results: There was no significant difference in age between the patient groups with (n = 86) and without (n = 114) intracranial haemorrhage (p = 0.078). In univariate logistic regression, GCS (OR = 0.419 (0.258; 0.680)) and thromboembolic event as reason for anticoagulant therapy (OR = 0.486 (0.257; 0.918)) were significantly associated with intracranial haemorrhage in patients with mild TBI and anticoagulation (all p < 0.05). However, there was no association with age (p = 0.078, OR = 1.024 (0.997; 1.051)), the type of accident or additional medication with acetylsalicylic acid or clopidogrel ((both p > 0.05; 0.552 (0.139; 2.202) and 0.256 (0.029; 2.237), respectively).

Conclusion: Our study found no association between age and intracranial bleeding. Therefore, until further risk factors are identified, diagnostic imaging with CCT remains necessary for mild TBI patients on oral anticoagulation of all ages, especially those with therapeutic anticoagulation because of thromboembolic events.

No MeSH data available.


Related in: MedlinePlus