Land, B. van ‘t (Bart) (2014) Impact of pre-injury antiplatelet agents and anticoagulants on outcomes in patients with traumatic brain injury. thesis, Medicine.
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Abstract
Background: Due to a more aging population in combination with an related increased incidence of cardiovascular diseases, pre-injury use of antiplatelet agents and anticoagulants are becoming more commonly seen within patients admitted with a traumatic brain injury. These medications could potentially have an adverse effect on patients outcome and therefor this study was performed to examine their possible impact on patients mortality and other important outcomes. Method: A 48 month (January 2010 till December 2013) retrospective review of data, containing patients admitted due to traumatic brain injury at the level-1 trauma center of the Academic Medical Center in Amsterdam, was performed. Patients on antiplatelet medication, anticoagulants and novel oral anticoagulants were individually compared to those not on these medications. Primary outcome was in-hospital mortality. Secondary outcomes included incidence of intracranial hemorrhage, with subsequent in-hospital mortality, and length of intensive care stay in addition to total hospital stay and patients discharge location. A separate analysis was performed to examine the effect of the assigned reversal strategy on patients survival. Results: Among the 432 patients that met the inclusion criteria, 83 were known with pre-injury use of an antiplatelet agent or anticoagulant. Unfortunately, no novel oral anticoagulants were seen. After adjusting for potential confounders, patients on antiplatelet agents had a tendency of having an increased risk of mortality ([OR], 2.79; 95% CI, 1.00-7.78; p = 0.05) but anticoagulant users did show this increased risk ([OR], 3.72; 95% CI, 1.06-13.02; p = 0.04). No increased risk of mortality was seen, among either, within patients with an intracranial hemorrhage and no significant effect of the assigned reversal strategy was seen. After adjustments, no differences were noted when comparing length of stays, and among discharge only anticoagulant users had a tendency to be discharged to a care facility. Conclusion: Patients known with pre-injury use of either a antiplatelet agent or anticoagulant show a tendency of having an increased independent risk of mortality.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Balvers, Drs. K. and Goslings, Prof. dr. J.C. MD PhD and Juffermans, Dr. N.P. MD PhD and AMC, Amsterdam and Munzebrock, Dr. A.V.E. and MCL, Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:54 |
| Last Modified: | 25 Jun 2020 10:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1469 |
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