Outcomes in Traumatic Brain Injury Patients on Preinjury Anticoagulation and Antiplatelet Agents

Traumatic brain injury (TBI) affects an estimated 1.7 million people a year. Around 75% of these cases are mild. Falls and motor vehicle accidents are among the leading causes for TBI, with falls accounting for 60.7% of occurrences in populations 65 years or older1. As the general population continues to expand both in age and in size, the risk of falls will increase. This poses a problem particularly in light of the pervasive use of anticoagulants and antiplatelet agents for this population, both of which increase the bleeding risk. Anticoagulants and antiplatelet agents are used for a variety of conditions, including deep venous thrombosis, atrial fibrillation, pulmonary embolism and coronary artery disease. They are also given postoperatively for prosthetic heart valves or stent placement. An estimated 597,689 deaths in 2010 were due to cardiovascular disease, with 80% above the age of 652. Stroke caused 129,476 deaths. The use of anticoagulants and antiplatelet agents for prevention of cardiovascular and cerebrovascular events is irrefutable, but little literature has touched on its effects on morbidity and mortality in those with traumatic brain injury. This article summarizes the current literature on the pre-TBI use of anticoagulants and antiplatelet agents and the associated morbidity and mortality