TY - JOUR
T1 - Impact of Antithrombotic Agents on Radiological Lesion Progression in Acute Traumatic Brain Injury
T2 - A CENTER-TBI Propensity-Matched Cohort Analysis
AU - Mathieu, Francois
AU - Gueting, Helge
AU - Gravesteijn, Benjamin
AU - Monteiro, Miguel
AU - Ben Glocker, null
AU - Kornaropoulos, Evgenios N.
AU - Kamnistas, Konstantinos
AU - Robertson, Claudia S.
AU - Levin, Harvey
AU - Whitehouse, Daniel P.
AU - Das, Tilak
AU - Lingsma, Hester F.
AU - Maegele, Marc
AU - Newcombe, Virginia F. J.
AU - Menon, David K.
AU - Collaborative European NeuroTrauma
AU - van Heugten, Caroline M.
N1 - Funding Information:
Data used in preparation of this article were obtained in the context of Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI), a large collaborative project with the support of the European Union 7th Framework program (EC grant 602150). FM has received salary support for dedicated research time from the Canada Cambridge Scholarship funded by the Cambridge Commonwealth Trust. VN is supported by an Academy of Medical Sciences/The Health Foundation Clinician Scientist Fellowship. These studies were also supported by infrastructure provided by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Center (BRC), a partnership between the Cambridge University Hospitals National Health Service (NHS) Foundation Trust and the University of Cambridge, funded by the NIHR. In addition, DKM was supported by an NIHR Senior Investigator Award.
Publisher Copyright:
© 2020, Mary Ann Liebert, Inc., publishers.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - 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.
AB - 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.
KW - anticoagulant
KW - antiplatelet
KW - intracranial hemorrhage
KW - traumatic brain injury
KW - PREINJURY WARFARIN
KW - INTRACEREBRAL HEMORRHAGE
KW - ANTIPLATELET AGENTS
KW - HEAD-INJURY
KW - RISK
KW - OUTCOMES
KW - ANTICOAGULATION
KW - SEGMENTATION
KW - CLOPIDOGREL
KW - MORTALITY
U2 - 10.1089/neu.2019.6911
DO - 10.1089/neu.2019.6911
M3 - Article
SN - 0897-7151
VL - 37
SP - 2069
EP - 2080
JO - Journal of Neurotrauma
JF - Journal of Neurotrauma
IS - 19
ER -