Therapeutic anticoagulation in patients with traumatic brain injury.
Therapeutic anticoagulation (TAC) is often required in trauma patients for various indications. However, it remains unknown whether TAC can be safely initiated in the postinjury period for patients with traumatic brain injury (TBI). The purpose of this study was to evaluate the safety of TAC in TBI patients.



We conducted a 7-y retrospective study. All TBI patients who received TAC within 60 d postinjury were included. In addition to patient and injury characteristics, detailed information regarding TAC was collected. The primary outcome was the incidence of neurologic deterioration or progression of hemorrhagic TBI on repeat head computed tomography (CT) after initiation of TAC. Univariate and multivariate analyses were used to identify factors associated with progression of hemorrhagic TBI after TAC.



A total of 3355 TBI patients were identified. Of those, 72 patients (2.1%) received TAC. Median age, 59; 76.4% male; median Injury Severity Score, 19; median admission Glasgow Coma Scale, 14; and median Rotterdam score on the initial head CT, 3. Although atrial fibrillation was the most common preinjury indication for TAC, venous thromboembolism was the most common postinjury indication. The median postinjury time of initiation of TAC was 9 d. Intravenous heparin infusion was the most commonly used agent for TAC (70.8%). None of our study patients developed any signs of neurologic deterioration due to TAC. Progression of hemorrhagic TBI on repeat head CT was observed in six patients. In a multiple logistic regression model, aged ≥65 y was significantly associated with progression of hemorrhagic TBI after TAC (odds ratio, 15.2; 95% confidence interval, 1.1-212.7; P = 0.04).



This study shows preliminary data regarding TAC initiated in patients with TBI. Further prospective study is warranted to determine the risks and benefits of TAC in this specific group of patients.
Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California. Electronic address: kazuhide.matsushima@med.usc.edu.
Kazuhide
K
Matsushima
Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
Kenji
K
Inaba
Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
Jayun
J
Cho
Department of Radiology, University of Southern California, Los Angeles, California.
Hussan
H
Mohammed
Department of Radiology, University of Southern California, Los Angeles, California.
Keith
K
Herr
Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
Stefan
S
Leichtle
Department of Neurosurgery, University of Southern California, Los Angeles, California.
Gabriel
G
Zada
Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
Demetrios
D
Demetriades
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D020201:Brain Hemorrhage, Traumatic / Q000150:complications; D000070642:Brain Injuries, Traumatic / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants
Outcome; Safety; Therapeutic anticoagulation; Traumatic brain injury