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

Abstract

BackgroundPatients 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.MethodsThis 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.ResultsThere 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).ConclusionOur 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.

Intracranial haemorrhage detected by cerebral computed tomography after falls in hospital acute medical wards

“…However, another study in patients with head injury on antithrombotic medications showed that loss of consciousness at the time of fall predicted ICH on CTB, independent of a normal CGS at the time of presentation to ED. [16]…”

“…However, the heterogeneity of the included studies makes it difficult to directly compare those results with our study. The association of age and dementia with post-fall ICH is also unclear [10, 14, 16]. Older age and dementia may be risk factors for traumatic ICH as cerebral atrophy is correlated with ICH after head trauma in patients over 60 years old [25].…”

“…Such established risk factors for ICH in community studies include a history of hypertension, antiplatelet and anticoagulant medication use, and neurological symptoms (vomiting, amnesia, headache and loss of consciousness) [13–15]. Some factors such as age and dementia remain controversial [10, 14, 16]. Other potential risk factors remain theoretical but have a physiological basis for concern.…”

Bleeding and Thromboembolism After Traumatic Brain Injury in the Elderly: A Real Conundrum

“…[1][2][3][4][5][6][7][8][9][10][11] After TBI, surgeons are reluctant to restart anticoagulants based on a perceived risk of recurrent injury. [2][3][4][5][6][7][8][9][10][11] However, guidelines from other societies (particularly neurology and cardiology) are consistent in their assessment that even in elderly patients with frequent falls, anticoagulation likely reduces overall risk of death. [12][13][14] These recommendations are primarily based on the well-established risk of stroke and one study using a Markov model that suggests that a patient would need to fall 295 times a year to increase their risk of TBI compared with the stroke reduction benefit seen with warfarin.…”