Characteristics and prognosis of patients admitted to a hospital emergency department for traumatic brain injury and with anticoagulant or antiplatelet treatment

Abstract

Background and objective: To determine mortality and complications of patients with traumatic brain injury (TBI) with antiplatelet or anticoagulant treatment in a hospital emergency department.

Materials and methods: Study of hospital cohorts of the 243 patients who attended with pure TBI to the emergency service of the Arnau de Vilanova University Hospital in Lleida between June 1, 2015 and June 1, 2016. Sociodemographic, clinical and other variables related to clinical management were collected. Presence of complications and in-hospital mortality were registered at 24hours, at 48hours and one week after TBI.

Results: Overall, 50.2% of patients were men, with median age of 80.8years, and without CT-scan findings at admission in 62.3% of cases. A total of 14 patients died (5.8%). Overall mortality was associated with comorbidity, with knowledge loss and with fluctuation of the Glasgow comma scale in the acute process. Patients treated with anticoagulants (39.5%) or antiplatelet agents (33.3%) were older, with higher degree of dependency and more comorbidity, but did not present more complications. Without reaching statistical significance, higher mortality was observed during the first week in anticoagulated patients (7.3% vs 4.8%, P=.585) or with antiplatelet treatment (8.6% vs 4.3%, P=.241) with respect to those not treated.

Conclusions: No worse results have been observed in number of complications in patients with TBI treated with anticoagulant or antiplatelet treatment, so clinical management seems appropriate. The higher mortality could be explained by the greater complexity of these patients. It would be necessary to carry out more studies, preferably prospective with follow-up after discharge, in order to establish causal mechanisms between clinical management and mortality or associated complications to TBI.

Keywords: Anticoagulación; Anticoagulant treatment; Emergencies; Mortalidad; Mortality; Traumatic brain injury; Traumatismo craneoencefálico; Urgencias.