Impact of Antithrombotic Agents on Radiological Lesion Progression in Acute Traumatic Brain Injury: A CENTER-TBI Propensity-Matched Cohort Analysis.
Kornaropoulos, Evgenios N
Robertson, Claudia S
Lingsma, Hester F
Menon, David K
Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants,
Journal of neurotrauma
Mary Ann Liebert
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Mathieu, F., Güting, H., Gravesteijn, B., Monteiro, M., Glocker, B., Kornaropoulos, E. N., Kamnistas, K., et al. (2020). Impact of Antithrombotic Agents on Radiological Lesion Progression in Acute Traumatic Brain Injury: A CENTER-TBI Propensity-Matched Cohort Analysis.. Journal of neurotrauma, 37 (19), 2069-2080. https://doi.org/10.1089/neu.2019.6911
An increasing number of elderly patients are being affected by TBI and a significant proportion are on pre-hospital antithrombotic therapy for cardio- or cerebrovascular indications. We have quantified the impact of antiplatelet/anticoagulant (APAC) agents on radiological lesion progression in acute TBI, using a novel, semi-automated approach to volumetric lesion measurement, and explored the impact of use on clinical outcomes in the CENTER-TBI study. We used a 1:1 propensity-matched cohort design, matching controls to APAC users based on demographics, baseline clinical status, pre-injury comorbidities and injury severity. Subjects were selected from a pool of patients enrolled in CENTER-TBI with computed tomography (CT) scan at admission and repeated within 7d of injury. We calculated absolute changes in volume of intraparenchymal, extra-axial, intraventricular and total intracranial hemorrhage between scans, and compared volume of hemorrhagic progression, proportion of patients with significant degree of progression (>25% of initial volume), proportion with new intracranial hemorrhage on follow-up CT as well as clinical course and outcomes. A total of 316 patients were included (158 APAC users; 158 controls). The mean volume of progression was significantly higher in the APAC group for extra-axial (3.1 vs 1.3 mL, p=0.01), but not intraparenchymal (3.8 vs 4.6 mL, p=0.65), intraventricular (0.2 vs 0.0 mL, p=0.79) or total intracranial hemorrhage (7.0 vs 6.0 mL, p=0.08). More patients had significant hemorrhage growth (54.1 vs 37.0%, p=0.003) and delayed intracranial hemorrhage (4 of 18 vs none; p=0.04) in the APAC group compared to controls, but this was not associated with differences in length of stay, rates of neurosurgical intervention, mortality or GOSE at 6 months. Preinjury use of antithrombotic agents was associated with greater expansion of extra-axial lesions, higher rates of significant hemorrhagic progression and higher risk of delayed traumatic intracranial hemorrhage, but this was not associated with worse clinical course or functional outcomes.
Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants
Data used in preparation of this manuscript were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Union 7th Framework program (EC grant 602150). FM has received salary support for dedicated research time from the Canada Cambridge Scholarship funded by the Cambridge Commonwealth Trust. VN is supported by an Academy of Medical Sciences / The Health Foundation Clinician Scientist Fellowship. These studies were also supported by infrastructure provided by the NIHR Cambridge Biomedical Research Centre (BRC) is a partnership between Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge, funded by the National Institute for Health Research (NIHR). In addition, DKM was supported by an NIHR Senior Investigator Award. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Academy of Medical Sciences (unknown)
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External DOI: https://doi.org/10.1089/neu.2019.6911
This record's URL: https://www.repository.cam.ac.uk/handle/1810/304254
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