The impact of preinjury consumption of antithrombotic drugs on clinical outcomes of patients with moderate to severe traumatic brain injury

The main goal of the present study was to investigate the impact of preinjury intake of direct oral anticoagulants (DOACs), warfarin, and antiplatelet on clinical and radiological neuro-deterioration of patients with moderate to severe traumatic brain injury (TBI).

We investigated 224 consecutive patients more than 50 years old with moderate and severe TBI admitted to the Taleghani hospital, Kermanshah, Iran, between Jul 2014 and Jul 2019, retrospectively. Demographic, clinical, and laboratory data were retrospectively reviewed using the electronic medical records of all patients. Patients were categorized into four groups: nonuser patients, patients on platelet inhibitors, patients on warfarin and patients taking any DOACs. Clinical outcome was evaluated with the Glasgow Outcome Scale.

95 patients (42.4%) received no anti thrombotic drugs before the trauma. However, 69 patients (30.8%) were receiving platelet inhibitors, 42 subjects (18.8%) were on the warfarin, and 18 cases (8.0%) were on the DOACs before their trauma. There were 41 cases (18.3%) with in-hospital mortality. Our results showed that, 108 patients (48.2%) had a favorable outcome and 116 ones (51.8%) had an unfavorable outcome. Patients on Warfarin and those were receiving DOACs were associated with higher mortality as well as a more unfavorable clinical outcome (p<0.005).

Preinjury use of DOACs and warfarin is associated with higher mortality and worse clinical outcome. However, preinjury antiplatelet therapy did not contribute to in-hospital mortality and poor clinical outcomes.