Anticoagulation is Associated with Increased Morbidity and Mortality in Concussive Injury Among Elderly Trauma Patients

Krishna Akella; Samer Ibrahim; Brian Boden; Akella Chendrasekhar

Volume : VIII, Issue : V, May - 2019

Anticoagulation is Associated with Increased Morbidity and Mortality in Concussive Injury Among Elderly Trauma Patients

Krishna Akella, Samer Ibrahim, Brian Boden, Akella Chendrasekhar

Abstract :

To study the association between concussive injury in elderly patients on anticoagulation and development of non–bleeding complication.

A retrospective data analysis was performed comp� elderly trauma patients with concussion on antiplatelet therapy, anticoagulation or both. Data obtained included age, ISS, likelihood of development mental status alteration, change in CT scan, hospital length of stay, and survival.

1000 patients patients age > 65 years [elderly] with concussion were enrolled, 622 women and 378 men, all on either antiplatelet therapy, anticoagulation or dual therapy. Patients had an average age of 80 years with average ISS of 1.4. Between the 3 groups (antiplatelet, anticoagulation and dual therapy), notable differences were found in alteration of mental status requiring the obtaining of a repeat CT scan (44% vs. 63% vs. 85%, p < .0001), changes noted in CT scan at 24 hours (8% vs. 19% vs. 56%, p< .0001), hospital length of stay (days) (4.5 vs. 5.1 vs. 6.0, p < .0001), and survival (100% vs. 94% vs. 85%, p < .0001). We also noted a significant difference between patients on aspirin or clopidogrel with regard to hospital length of stay (days) (4.2 vs. 5.4, p < .0001).

Elderly patients on antiplatelet therapy with concussive injury were less prone to develop morbidity such mental status changes, changes in CT at 24 hours and prolonged hospital length of stay when compared to patients on anticoagulation or dual therapy. With 100% survival and hospital length of stay ranging between 4.2 to 5.4 days, raises questions with regard to resource allocation in concussed patients on only antiplatelet therapy. In patients on anticoagulation with or without antiplatelet therapy, changes in CT scan were unrelated to bleeding but more commonly found to be due to worsening of chronic conditions –– edema and prior infarction – possibly related to withholding of anticoagulation or antiplatelet therapy.

Concussive injury in patients on anticoagulation is associated with a higher morbidity and mortality than patients with similar injury only on antiplatelet therapy. The change in mental status even with antiplatelet therapy would suggest observing these patients for at least 24 hours.