Association between antithrombotic medications and intracranial hemorrhage among older patients with mild traumatic brain injury: a multicenter cohort study.
Authors
Affiliations (8)
Affiliations (8)
- Emergency Department, Research Center, CHU de Québec-Université Laval, Québec, Québec, Canada.
- Emergency Department, Centre Hospitalier Universitaire Édouard Herriot-Université Claude Bernard Lyon 1.
- Research and Innovation Department, IMADIS Groupe, Lyon.
- Department of Radiology, Pellegrin University Hospital.
- SARCOTARGET Team, University of Bordeaux, INSERM, UMR1312, BRIC, Bordeaux Institute of Oncology, Bordeaux.
- Department of Radiology, Edouard Herriot Hospital.
- Department of Radiology, Saint Joseph Saint Luc Hospital, Lyon.
- Department of Radiology, Clinique Bouchard, ELSAN, Marseille, France.
Abstract
To measure the association between antithrombotic (AT) medications (anticoagulant and antiplatelet) and risk for traumatic intracranial hemorrhage (ICH) in older adults with a mild traumatic brain injury (mTBI). We conducted a retrospective multicenter study across 103 emergency departments affiliated with a teleradiology company dedicated to emergency imaging between 2020 and 2022. Older adults (≥65 years old) with mTBI, with a head computed tomography scan, were included. Natural language processing models were used to label-free texts of emergency physician forms and radiology reports; and a multivariable logistic regression model to measure the association between AT medications and occurrence of ICH. A total of 5948 patients [median age 84.6 (74.3-89.1) years, 58.1% females] were included, of whom 781 (13.1%) had an ICH. Among them, 3177 (53.4%) patients were treated with at least one AT agent. No AT medication was associated with a higher risk for ICH: antiplatelet odds ratio 0.98 95% confidence interval (0.81-1.18), direct oral anticoagulant 0.82 (0.60-1.09), and vitamin K antagonist 0.66 (0.37-1.10). Conversely, a high-level fall [1.68 (1.15-2.4)], a Glasgow coma scale of 14 [1.83 (1.22-2.68)], a cutaneous head impact [1.5 (1.17-1.92)], vomiting [1.59 (1.18-2.14)], amnesia [1.35 (1.02-1.79)], a suspected skull vault fracture [9.3 (14.2-26.5)] or of facial bones fracture [1.34 (1.02-1.75)] were associated with a higher risk for ICH. This study found no association between AT medications and an increased risk of ICH among older patients with mTBI suggesting that routine neuroimaging in this population may offer limited benefit and that additional variables should be considered in the imaging decision.