Journal article
Eastern Association for the Surgery of Trauma Multicenter Trial: Comparison of pre-injury antithrombotic use and reversal strategies among severe traumatic brain injury patients
The journal of trauma and acute care surgery, v 92(1), pp 88-92
01 Jan 2022
PMID: 34570064
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: Trauma teams are often faced with patients on antithrombotic (AT) drugs, which is challenging when bleeding occurs. We sought to compare the effects of different AT medications on head injury severity and hypothesized that AT reversal would not improve mortality in severe traumatic brain injury (TBI) patients.
METHODS: An Eastern Association for the Surgery of Trauma-sponsored prospective, multicentered, observational study of 15 trauma centers was performed. Patient demoglaphics, injury burden, comorbidities, AT agents, and reversal attempts were collected. Outcomes of interest were head injury severity and in-hospital mortality.
RESULTS: Analysis was performed on 2,793 patients. The majority of patients were on aspirin (acetylsalicylic acid [ASA], 46.1%). Patients on a platelet chemoreceptor blocker (P2Y12) had the highest mean Injury Severity Score (9.1 +/- 8.1). Patients taking P2Y12 inhibitors +/- ASA, and ASA-warfarin had the highest head Abbreviated Injury Scale (AIS) mean (1.2 +/- 1.6). On risk-adjusted analysis, warfarin-ASA was associated with a higher head AIS (odds ratio [OR], 2.43; 95% confidence interval [Cl], 1.34 4.42) after controlling for Injury Severity Score, Charism Comorbidity Index, initial Glasgow Coma Scale score, and initial systolic blood pressure. Among patients with severe TBI (head AIS score, >= 3) on antiplatelet therapy, reversal with desmopressin (DDAVP) and/or platelet transfusion did not improve survival (82.9% reversal vs. 90.4% none,p = 0.30). In severe TBI patients taking Xa inhibitors who received prothrombin complex concentrate, survival was not improved (84.6% reversal vs. 84.6% none,p = 0.68). With risk adjustment as described previously, mortality was not improved with reversal attempts (antiplatelet agents: OR 0.83; 85% CI, 0.12-5.9 [p = 0.85]; Xa inhibitors: OR, 0.76; 95% CI, 0.12-4.64; p = 0.77).
CONCLUSION: Reversal attempts appear to confer no mortality benefit in severe TBI patients on antiplatelet agents or Xa inhibitors. Combination therapy was associated with severity of head injury among patients taking preinjury AT therapy, with ASA-warfarin possessing the greatest risk. Copyright (C) 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Details
- Title
- Eastern Association for the Surgery of Trauma Multicenter Trial: Comparison of pre-injury antithrombotic use and reversal strategies among severe traumatic brain injury patients
- Creators
- Brian K. Yorkgitis - Univ Florida, Coll Med, Dept Surg, 653 W 8th St, Jacksonville, FL 32209 USADanielle M. Tatum - RmcSharven Taghavi - College Station Medical CenterThomas J. Schroeppel - Mécanique et Engrenage ModerneMatthew R. Noorbakhsh - Allegheny Hlth Network, Dept Surg, Pittsburgh, PA USAFrances Hite Philps - Allegheny Hlth Network, Dept Surg, Pittsburgh, PA USANikolay Bugaev - College Station Medical CenterKaushik Mukherjee - Loma Linda UniversityMellody Bellora - Loma Linda UniversityAdrian W. Ong - Reading Hosp Tower Hlth, Dept Surg, Reading, PA USAAsanthi Ratnasekera - Crozer Keystone Hlth Syst, Dept Surg, Upland, PA USAKristen D. Nordham - Tulane UniversityMatthew M. Carrick - College Station Medical CenterJames M. Haan - Via Christi Hosp Wichita, Dept Surg, Wichita, KS USAKelly L. Lightwine - Via Christi Hosp Wichita, Dept Surg, Wichita, KS USALawrence Lottenberg - St Marys Hosp, Dept Surg, W Palm Beach, FL USARobert Borrego - St Marys Hosp, Dept Surg, W Palm Beach, FL USADaniel C. Cullinane - College Station Medical CenterJohn D. Berne - College Station Medical CenterDalier Rodriguez Mederos - College Station Medical CenterThomas Z. Hayward - Indiana UniversityAndy J. Kerwin - Univ Florida, Coll Med, Dept Surg, 653 W 8th St, Jacksonville, FL 32209 USAMarie Crandall - Univ Florida, Coll Med, Dept Surg, 653 W 8th St, Jacksonville, FL 32209 USA
- Publication Details
- The journal of trauma and acute care surgery, v 92(1), pp 88-92
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 5
- Grant note
- Eastern Association for the Surgery of Trauma Junior Investigator Award
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000731994300020
- Scopus ID
- 2-s2.0-85122308685
- Other Identifier
- 991022020638404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Surgery