Impact of Antithrombotic Agents on Radiological Lesion Progression in Acute Traumatic Brain Injury: A CENTER-TBI Propensity-Matched Cohort Analysis

CENTER-TBI investigators and participants, Francois Mathieu*, Helge Gueting, Benjamin Gravesteijn, Miguel Monteiro, Ben Glocker, Evgenios N. Kornaropoulos, Konstantinos Kamnistas, Claudia S. Robertson, Harvey Levin, Daniel P. Whitehouse, Tilak Das, Hester F. Lingsma, Marc Maegele, Virginia F. J. Newcombe, David K. Menon

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)

Abstract

An increasing number of elderly patients are being affected by traumatic brain injury (TBI) and a significant proportion are on pre-hospital antithrombotic therapy for cardio- or cerebrovascular indications. We have quantified the impact of antiplatelet/anticoagulant (APAC) agents on radiological lesion progression in acute TBI, using a novel, semi-automated approach to volumetric lesion measurement, and explored the impact of use on clinical outcomes in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We used a 1:1 propensity-matched cohort design, matching controls to APAC users based on demographics, baseline clinical status, pre-injury comorbidities, and injury severity. Subjects were selected from a pool of patients enrolled in CENTER-TBI with computed tomography (CT) scan at admission and repeated within 7 days of injury. We calculated absolute changes in volume of intraparenchymal, extra-axial, intraventricular, and total intracranial hemorrhage (ICH) between scans, and compared volume of hemorrhagic progression, proportion of patients with significant degree of progression (>25% of initial volume), proportion with new ICH on follow-up CT, as well as clinical course and outcomes. A total of 316 patients were included (158 APAC users; 158 controls). The mean volume of progression was significantly higher in the APAC group for extra-axial (3.1 vs. 1.3 mL, p = 0.01), but not intraparenchymal (3.8 vs. 4.6 mL, p = 0.65), intraventricular (0.2 vs. 0.0 mL, p = 0.79), or total intracranial hemorrhage (ICH; 7.0 vs. 6.0 mL, p = 0.08). More patients had significant hemorrhage growth (54.1 vs. 37.0%, p = 0.003) and delayed ICH (4 of 18 vs. none; p = 0.04) in the APAC group compared with controls, but this was not associated with differences in length of stay (LOS), rates of neurosurgical intervention, mortality or Glasgow Outcome Scale Extended (GOS-E) score at 6 months. Pre-injury use of antithrombotic agents was associated with greater expansion of extra-axial lesions, higher rates of significant hemorrhagic progression, and higher risk of delayed traumatic ICH, but this was not associated with worse clinical course or functional outcomes.

Original languageEnglish
Pages (from-to)2069-2080
Number of pages12
JournalJournal of Neurotrauma
Volume37
Issue number19
DOIs
Publication statusPublished - 1-Oct-2020

Keywords

  • anticoagulant
  • antiplatelet
  • intracranial hemorrhage
  • traumatic brain injury
  • PREINJURY WARFARIN
  • INTRACEREBRAL HEMORRHAGE
  • ANTIPLATELET AGENTS
  • HEAD-INJURY
  • RISK
  • OUTCOMES
  • ANTICOAGULATION
  • SEGMENTATION
  • CLOPIDOGREL
  • MORTALITY

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