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    Bleeding and Thromboembolism After TBI in the Elderly: A Real Conundrum

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    Author
    Glass, N.E.
    Vadlamani, A.
    Hwang, F.
    Date
    2019
    Journal
    Journal of Surgical Research
    Publisher
    Academic Press Inc.
    Type
    Article
    
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    See at
    https://doi.org/10.1016/j.jss.2018.10.021
    Abstract
    Background: Elderly patients presenting with a traumatic brain injury (TBI) often have comorbidities that increase risk of thromboembolic (TE) disease and recurrent TBI. A significant number are on anticoagulant therapy at the time of injury and studies suggest that continuing anticoagulation can prevent TE events. Understanding bleeding, recurrent TBI, and TE risk after TBI can help to guide therapy. Our objectives were to 1) evaluate the incidence of bleeding, recurrent TBI, and TE events after an initial TBI in older adults and 2) identify which factors contribute to this risk. Methods: Retrospective analysis of Medicare claims between May 30, 2006 and December 31, 2009 for patients hospitalized with TBI was performed. We defined TBI for the index admission, and hemorrhage (gastrointestinal bleeding or hemorrhagic stroke), recurrent TBI, and TE events (stroke, myocardial infarction, deep venous thrombosis, or pulmonary embolism) over the following year using ICD-9 codes. Unadjusted incidence rates and 95% confidence intervals (CIs) were calculated. Risk factors of these events were identified using logistic regression. Results: Among beneficiaries hospitalized with TBI, incidence of TE events (58.6 events/1000 person-years; 95% CI 56.2, 60.8) was significantly higher than bleeding (23.6 events/1000 person-years; 95% CI 22.2, 25.1) and recurrent TBI events (26.0 events/1000 person-years; 95% CI 24.5, 27.6). Several common factors predisposed to bleeding, recurrent TBI, and TE outcomes. Conclusions: Among Medicare patients hospitalized with TBI, the incidence of TE was significantly higher than that of bleeding or recurrent TBI. Specific risk factors of bleeding and TE events were identified which may guide care of older adults after TBI. Copyright 2018 Elsevier Inc.
    Keyword
    Anticoagulation
    Elderly
    Stroke
    Thromboembolic event
    Traumatic brain injury
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85057594881&doi=10.1016%2fj.jss.2018.10.021&partnerID=40&md5=de4cbd098821d9101dc752b2b03adbf4; http://hdl.handle.net/10713/10562
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jss.2018.10.021
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