Impact of Antithrombotic Agents on Radiological Lesion Progression in Acute Traumatic Brain Injury: A CENTER-TBI Propensity-Matched Cohort Analysis
Mathieu, Francois; Güting, Helge; Gravesteijn, Benjamin; Monteiro, Miguel; Glocker, Ben; Kornaropoulos, Evgenios; Kamnistas, Konstantinos; Robertson, Claudia; Levin, Harvey; Whitehouse, Daniel; Das, Tilak; Lingsma, Hester F; Maegele, Marc; Newcombe, Virginia F.J.; Menon, David K; Andelic, Nada; Andreassen, Lasse; Anke, Audny; Frisvold, Shirin; Helseth, Eirik; Røe, Cecilie; Røise, Olav; Skandsen, Toril; Vik, Anne; Åkerlund, Cecilia; Amrein, Krisztina; Antoni, Anna; Audibert, Gerard; Azouvi, Philippe; Azzolini, Maria Luisa; Bartels, Ronald; Barzo, Pal; Beauvais, Romuald; Beer, Ronny; Bellander, Bo-Michael; Belli, Antonio; Benali, Habib; Berardino, Maurizio; Beretta, Luigi; Blaabjerg, Morten; Bragge, Peter; Brazinova, Alexandra; Brinck, Vibeke; Brooker, Joanne; Brorsson, Camilla; Buki, Andras; Bullinger, Monika; Cabeleira, Manuel; Caccioppola, Alessio; Calappi, Emiliana; Calvi, Maria Rosa
Peer reviewed, Journal article
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Original versionJournal of Neurotrauma. 2020, 37 (19), 2069-2080. 10.1089/neu.2019.6911
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.