Prevalence and Predictors of Inappropriate Antithrombotic Prescription in Patients Presenting With Traumatic Brain Injury.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
26 May 2023
26 May 2023
Historique:
received:
21
12
2022
accepted:
29
03
2023
medline:
27
5
2023
pubmed:
27
5
2023
entrez:
26
5
2023
Statut:
aheadofprint
Résumé
A growing proportion of the US population is on antithrombotic therapy (AT), most significantly within the older subpopulation. Decision to use AT is a balance between the intended benefits and known bleeding risk, especially after traumatic brain injury (TBI). Preinjury inappropriate AT offers no benefit for the patient and also increases the risk of intracranial hemorrhage and worse outcome in the setting of TBI. Our objective was to examine the prevalence and predictors of inappropriate AT among patients presenting with TBI to a Level-1 Trauma Center. A retrospective chart review was performed on all patients with TBI and preinjury AT who presented to our institution between January 2016 and September 2020. Demographic and clinical data were collected. Appropriateness of AT was determined through established clinical guidelines. Clinical predictors were determined by logistic regression. Of 141 included patients, 41.8% were female (n = 59) and the average age (mean ± SD) was 80.6 ± 9.9. The prescribed antithrombotic agents included aspirin (25.5%, n = 36), clopidogrel (22.7%, n = 32), warfarin (46.8%, n = 66), dabigatran (2.1%, n = 3), rivaroxaban (Janssen) (10.6%, n = 15), and apixaban (Bristol-Myers Squibb Co.) (18.4%, n = 26). The indications for AT were atrial fibrillation (66.7%, n = 94), venous thromboembolism (13.4%, n = 19), cardiac stent (8.5%, n = 12), and myocardial infarction/residual coronary disease (11.3%, n = 16). Inappropriate antithrombotic therapy use varied significantly by antithrombotic indication (P < .001) with the highest rates seen with venous thromboembolism. Predictive factors also include age (P = .005) with higher rates younger than 65 years and older than 85 years and female sex (P = .049). Race and antithrombotic agent were not significant predictors. Overall, 1 in 10 patients presenting with TBI were found to be on inappropriate AT. Our study is the first to describe this problem and warrants investigation into possible workflow interventions to prevent post-TBI continuation of inappropriate AT.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
A growing proportion of the US population is on antithrombotic therapy (AT), most significantly within the older subpopulation. Decision to use AT is a balance between the intended benefits and known bleeding risk, especially after traumatic brain injury (TBI). Preinjury inappropriate AT offers no benefit for the patient and also increases the risk of intracranial hemorrhage and worse outcome in the setting of TBI. Our objective was to examine the prevalence and predictors of inappropriate AT among patients presenting with TBI to a Level-1 Trauma Center.
METHODS
METHODS
A retrospective chart review was performed on all patients with TBI and preinjury AT who presented to our institution between January 2016 and September 2020. Demographic and clinical data were collected. Appropriateness of AT was determined through established clinical guidelines. Clinical predictors were determined by logistic regression.
RESULTS
RESULTS
Of 141 included patients, 41.8% were female (n = 59) and the average age (mean ± SD) was 80.6 ± 9.9. The prescribed antithrombotic agents included aspirin (25.5%, n = 36), clopidogrel (22.7%, n = 32), warfarin (46.8%, n = 66), dabigatran (2.1%, n = 3), rivaroxaban (Janssen) (10.6%, n = 15), and apixaban (Bristol-Myers Squibb Co.) (18.4%, n = 26). The indications for AT were atrial fibrillation (66.7%, n = 94), venous thromboembolism (13.4%, n = 19), cardiac stent (8.5%, n = 12), and myocardial infarction/residual coronary disease (11.3%, n = 16). Inappropriate antithrombotic therapy use varied significantly by antithrombotic indication (P < .001) with the highest rates seen with venous thromboembolism. Predictive factors also include age (P = .005) with higher rates younger than 65 years and older than 85 years and female sex (P = .049). Race and antithrombotic agent were not significant predictors.
CONCLUSION
CONCLUSIONS
Overall, 1 in 10 patients presenting with TBI were found to be on inappropriate AT. Our study is the first to describe this problem and warrants investigation into possible workflow interventions to prevent post-TBI continuation of inappropriate AT.
Identifiants
pubmed: 37235974
doi: 10.1227/neu.0000000000002540
pii: 00006123-990000000-00750
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
Références
Puckett Y, Zhang K, Blasingame J, et al. Safest time to resume oral anticoagulation in patients with traumatic brain injury. Cureus. 2018;10(7):e2920.
van den Brand CL, Tolido T, Rambach AH, Hunink MGM, Patka P, Jellema K. Systematic review and meta-analysis: is pre-injury antiplatelet therapy associated with traumatic intracranial hemorrhage?. J Neurotrauma. 2017;34(1):1-7.
Scotti P, Séguin C, Lo BWY, de Guise E, Troquet JM, Marcoux J. Antithrombotic agents and traumatic brain injury in the elderly population: hemorrhage patterns and outcomes. J Neurosurg. 2020;133(2):486-495.
Powers AY, Pinto MB, Tang OY, Chen JS, Doberstein C, Asaad WF. Predicting mortality in traumatic intracranial hemorrhage. J Neurosurg. 2020;132(2):552-559.
King B, Milling T, Gajewski B, et al. Restarting and timing of oral anticoagulation after traumatic intracranial hemorrhage: a review and summary of ongoing and planned prospective randomized clinical trials. Trauma Surg Acute Care Open. 2020;5(1):e000605.
Sumiyoshi K, Hayakawa T, Yatsushige H, et al. Outcome of traumatic brain injury in patients on antiplatelet agents: a retrospective 20-year observational study in a single neurosurgery unit. Brain Inj. 2017;31(11):1445-1454.
Mathieu F, Güting H, Gravesteijn B, et al. Impact of antithrombotic agents on radiological lesion progression in acute traumatic brain injury: a CENTER-TBI propensity-matched cohort analysis. J Neurotrauma. 2020;37(19):2069-2080.
Hsu JC, Chan PS, Tang F, Maddox TM, Marcus GM. Oral anticoagulant prescription in patients with atrial fibrillation and a low risk of thromboembolism: insights from the NCDR PINNACLE Registry. JAMA Intern Med. 2015;175(6):1062-1065.
Jang BM, Lee OS, Shin EJ, et al. Factors related to inappropriate edoxaban use. J Clin Pharm Ther. 2019;44(5):760-767.
Admassie E, Chalmers L, Bereznicki LR. Changes in oral anticoagulant prescribing for stroke prevention in patients with atrial fibrillation. Am J Cardiol. 2017;120(7):1133-1138.
Hussain S, Gebran N, Hussain K, Soliman K. Drug use evaluation of dabigatran in a tertiary care hospital in United Arab Emirates. Eur J Hosp Pharm. 2012;20(2):106-109.
Larock AS, Mullier F, Sennesael AL, et al. Appropriateness of prescribing dabigatran etexilate and rivaroxaban in patients with nonvalvular atrial fibrillation: a prospective study. Ann Pharmacother. 2014;48(10):1258-1268.
Sørensen R, Gislason G, Torp-Pedersen C, et al. Dabigatran use in Danish atrial fibrillation patients in 2011: a nationwide study. BMJ Open. 2013;3(5):e002758.
Farsi D, Karimi P, Mofidi M, et al. Effects of Pre-injury anti-platelet agents on short-term outcome of patients with mild traumatic brain injury: a cohort study. Bull Emerg Trauma. 2017;5(2):110-115.
Sakr M, Wilson L. Aspirin and the risk of intracranial complications following head injury. Emerg Med J. 2005;22(12):891-892.
Lane DA, Lip GYH. Use of the CHA2DS2-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation. 2012;126(7):860-865.
Mauri L, Kereiakes DJ, Yeh RW, et al. Twelve or 30 Months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2014;371(23):2155-2166.
January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199-e267.
Senyei G, Fernandes T. Duration of anticoagulation post-PE: things to consider. American College of Cardiology. 2019; Accessed October 11, 2022. https://www.acc.org/latest-in-cardiology/articles/2019/03/22/07/45/http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2019%2f03%2f22%2f07%2f45%2fduration-of-anticoagulation-post-pe.
Weitz JI, Lensing AWA, Prins MH, et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017;376(13):1211-1222.
Agnelli G, Buller HR, Cohen A, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. 2013;368(8):699-708.
Nishijima DK, Gaona S, Waechter T, et al. Do EMS providers accurately ascertain anticoagulant and antiplatelet use in older adults with head trauma? Prehosp Emerg Care. 2017;21(2):209-215.
Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism: update on management and controversies. BMJ. 2020;370:m2177.
Khan F, Le Gal G, Rodger MA. Stopping anticoagulation in a woman with unprovoked venous thromboembolism. Can Med Assoc J. 2017;189(35):e1112–e1114.
Rodger M, Carrier M, Gandara E, Le Gal G. Unprovoked venous thromboembolism: short term or indefinite anticoagulation? Balancing long-term risk and benefit. Blood Rev. 2010;24(4-5):171-178.
Wittich CM, Burkle CM, Lanier WL. Medication errors: an overview for clinicians. Mayo Clin Proc. 2014;89(8):1116-1125.
Safer DJ. Overprescribed medications for US adults: four major examples. J Clin Med Res. 2019;11(9):617-622.
Chesser AK, Keene Woods N, Smothers K, Rogers N. Health literacy and older adults. Gerontol Geriatr Med. 2016;2:233372141663049.
Yong CM, Tremmel JA, Lansberg MG, Fan J, Askari M, Turakhia MP. Sex differences in oral anticoagulation and outcomes of stroke and intracranial bleeding in newly diagnosed atrial fibrillation. J Am Heart Assoc. 2020;9(10):e015689.
Cardoso LJ, Gassman-Pines A, Boucher NA. Insurance barriers, gendering, and access: interviews with central North Carolinian women about their health care experiences. Permanente J. 2021;25(2):1-3.
Steyerberg EW, Wiegers E, Sewalt C, et al. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol. 2019;18(10):923-934.
Dreijer AR, Diepstraten J, Leebeek FWG, Kruip MJHA, van den Bemt PMLA. The effect of hospital-based antithrombotic stewardship on adherence to anticoagulant guidelines. Int J Clin Pharm. 2019;41(3):691-699.
Yeh RW, Secemsky EA, Kereiakes DJ, et al. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA. 2016;315(16):1735-1749.
Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation. Chest. 2010;137(2):263-272.