Abstract Details

Title Do Anticoagulant or Anti-Platelets Agents Confer Undue Additional Morbidity in the Setting of Acute Traumatic Brain Injury?

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P03 - (-)

Poster/Presentation
Number 144

Objective

Background BACKGROUND: Given the rising use of ACAPs for various chronic conditions, the authors sought to study the impact of these medication on TBI outcome.

Design/Methods DESIGN/METHODS: This is an observational cohort study of adults who presented to the emergency department (ED) at a level-one trauma center serving over 1 million/yr. The trauma acuity is high, with >50% having Injury Severity Scale (ISS) scores >15. Data were input into RedCap, a secure web based system designed for clinical data capture. JMP 9.0 for the Macintosh was used for statistical analyses.

Results RESULTS: In the cohort of 2246, the median age was significantly different between those on ACAPs (median age 74, IQR 62-81) and those who weren't (median age 35, IQR 23-51). The proportion of whites were significantly higher in the ACAP group (83% vs. 79%, p=0.0066, 95% CI -0.25 to -0.155), while the percentage of Hispanics was significantly lower (1% vs. 5%, p=.0046, 95% CI=-0.123 to -0.0677). The ACAPs distributions were: 24% warfarain, 59% aspirin, 29% clopidogrel, 3% ticlodipine, 4% heparin, and 4% enoxaparin. After adjusting for age, patients on ACAPs were significantly more likely to be admitted to the hospital (p=.0372); be re-admitted within 30 days (p=.0017); and be dead at 3 months post TBI (p=0.0029). This group also had more severe TBIs (p=0.0130), more abnormal head CTs (p=.0375) and underwent neurosurgical intervention for their TBI (p=.0360) more often. Skull and maxillofacial fractures (p=.0.0301), as well as epidural hematomas (p<0.0001) were also significantly more common on the ACAP group.

Conclusions CONCLUSIONS: It appears that ACAP use confers additional morbidity in patients with acute TBI. Given the aging population, this burden needs to be recognized and proactive measures instituted.

Authors/Disclosures
Latha Ganti, MD, MS, MBA, FACEP PRESENTER	Dr. Ganti has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Ganti has received publishing royalties from a publication relating to health care.
Timothy Cunniff, PharmD	Dr. Cunniff has received personal compensation for serving as an employee of Paragon Biosciences. Dr. Cunniff has stock in Harmony Biosciences. Dr. Cunniff has stock in Emalex Biosciences.
	No disclosure on file
	No disclosure on file
Aakash N. Bodhit, MD (Dignity Health-St. Mary's Health Center)	No disclosure on file
Yasamin Daneshvar, BA	No disclosure on file
Bayard D. Miller, MD	No disclosure on file

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