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Abstract
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BACKGROUND: Traumatic brain injury (TBI) is a leading cause of injury-related deaths and neurological disability globally. Considering the widespread anticoagulant use among the aging population, we aimed to perform a systematic review and meta-analysis to evaluate the prognostic significance of preinjury anticoagulation in TBI patients.
METHODS: This systematic review was conducted according to a predefined protocol (PROSPERO registration number: CRD42020192323). In compliance with PRISMA and MOOSE standards, a structured electronic database search was undertaken to identify all observational studies comparing preinjury anticoagulation with no preinjury anticoagulation in TBI patients. The primary outcome measure was overall mortality. The secondary outcome measures comprised in-hospital mortality, length of hospital stay (LOS), length of intensive care unit (ICU) stay, need for neurosurgical procedure and number of patients discharged home. All outcome data was analysed using random effects modelling.
RESULTS: Twelve comparative studies enrolling a total of 4,417 patients were included. Preinjury anticoagulation was associated with higher risk of overall mortality (OR 2.39, 95% CI 1.63-3.50, ρ<0.00001), in-hospital mortality (OR 2.47, 95% CI 1.56-3.93, ρ=0.0001), and longer length of ICU stay (MD 1.06, 95% CI 0.54-1.57, ρ<0.0001) compared to no preinjury anticoagulation. No statistical difference was observed in LOS (MD -2.15, 95% CI -5.36-1.05, ρ=0.19), need for neurosurgical procedure (OR 1.30, 95% CI 0.70-2.44, ρ=0.41), and discharged home (OR 0.76, 95% CI 0.55-1.04, ρ=0.09) between the two groups.
CONCLUSIONS: Preinjury anticoagulation is a powerful prognosticator of mortality in TBI patients. This highlights the need for dedicated triage and trauma team activation protocols considering earlier intervention and more aggressive imaging in all anticoagulated patients. Future studies should focus on strategies that can potentially reduce the risk of mortality in this population. The prognostic significance of DOACs versus warfarin remains unanswered.
LEVEL OF EVIDENCE: Level III evidence, systematic review and meta-analysis of observational studies.
Language: en |