Outcome after Acute Head Trauma Needing Neurosurgical Intervention in Patients with Oral Anticoagulants or Anti-Thrombotic Agents
Journal of Trauma and Treatment
The benefit-to-risk-ratio of anticoagulation has been discussed over years in the medical literature. Even in minor Traumatic Brain Injury (TBI), anticoagulation can cause an intracranial hemorrhage. However, there is few data in literature on outcome in TBI, anticoagulation and surgery. The aim was to determine the effect of anticoagulation on outcome and mortality after TBI. Methods: We performed a retrospective review for patients after TBI needing neurosurgical intervention between January
... on between January 2003 and September 2008. We compared patients with and without anticoagulation, regarding mortality and outcome. Outcome variables were Karnofsky perfomance score (KPS) and Glasgow outcome scale (GOS). Statistical testing was done by means of Fisher´s exact test and a multiple logit model. Results : 293 patients met inclusion criteria. 245 (83.6%) were non anticoagulated patients, 48 (16.4%) received oral anticoagulation (OAC) or antithrombotic agents (ATH). Mean age in all patients was 49.3 years. Prothrombintime (PT), age, type of bleeding, neurological status on admission turned out as significant factors for mortality and outcome. Ranges of odds ratio for mortality went from 0.98 to 44.8, for KPS and GOS from 0.06 to 1.3. Anticoagulation was not a significant predicting factor for worse outcome or mortality (p 0.886; 0.926; 0.934). Conclusion: Age, neurological status on admission and compartment of bleeding are still the most significant prognostic factors for outcome after TBI. Low PT, higher age, comatose on admission, intracerebral hemorrhage, acute subdural hematomas and combined intracranial bleeding are factors predicting a worse outcome. Thus, the intensity of anticoagulation is an important factor, but not the use of these drugs itself.