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Impact of Antithrom...
Impact of Antithrombotic Agents on Radiological Lesion Progression in Acute Traumatic Brain Injury : A CENTER-TBI Propensity-Matched Cohort Analysis
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- Mathieu, François (författare)
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Anesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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- Güting, Helge (författare)
- Institute for Research in Operative Medicine (IFOM), Universität Witten/Herdecke, Witten, Germany
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- Gravesteijn, Benjamin (författare)
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
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- Monteiro, Miguel (författare)
- Biomedical Image Analysis Group, Imperial College London, London, United Kingdom
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- Glocker, Ben (författare)
- Biomedical Image Analysis Group, Imperial College London, London, United Kingdom
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- Kornaropoulos, Evgenios N. (författare)
- Division of Anesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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- Kamnistas, Konstantinos (författare)
- Biomedical Image Analysis Group, Imperial College London, London, United Kingdom
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- Robertson, Claudia S. (författare)
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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- Levin, Harvey (författare)
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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- Whitehouse, Daniel P. (författare)
- Division of Anesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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- Das, Tilak (författare)
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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- Lingsma, Hester F. (författare)
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
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- Maegele, Marc (författare)
- Institute for Research in Operative Medicine (IFOM), Universität Witten/Herdecke, Witten, Germany; Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, Cologne, Germany
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- Newcombe, Virginia F. J. (författare)
- Division of Anesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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- Menon, David K. (författare)
- Division of Anesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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- Brorsson, Camilla (författare)
- Umeå universitet,Anestesiologi och intensivvård
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- Oresic, Matej, 1967- (författare)
- Örebro universitet,Institutionen för medicinska vetenskaper
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, en Glocker (författare)
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Koskinen, Lars-Owe D., 1955- (bidragsgivare)
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(creator_code:org_t)
- Mary Ann Liebert, 2020
- 2020
- Engelska.
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Ingår i: Journal of Neurotrauma. - : Mary Ann Liebert. - 0897-7151 .- 1557-9042. ; 37:19, s. 2069-2080
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- An increasing number of elderly patients are being affected by traumatic brain injury (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 Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (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 7 days of injury. We calculated absolute changes in volume of intraparenchymal, extra-axial, intraventricular, and total intracranial hemorrhage (ICH) between scans, and compared volume of hemorrhagic progression, proportion of patients with significant degree of progression (>25% of initial volume), proportion with new ICH 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 (ICH; 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 ICH (4 of 18 vs. none; p = 0.04) in the APAC group compared with controls, but this was not associated with differences in length of stay (LOS), rates of neurosurgical intervention, mortality or Glasgow Outcome Scale Extended (GOS-E) score at 6 months. Pre-injury 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 ICH, but this was not associated with worse clinical course or functional outcomes.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
Nyckelord
- Anticoagulant
- antiplatelet
- intracranial hemorrhage
- traumatic brain injury
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- art (ämneskategori)
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Mathieu, Françoi ...
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Güting, Helge
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Gravesteijn, Ben ...
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Monteiro, Miguel
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Glocker, Ben
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Kornaropoulos, E ...
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Kamnistas, Konst ...
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Robertson, Claud ...
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Levin, Harvey
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Whitehouse, Dani ...
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Das, Tilak
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Lingsma, Hester ...
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Maegele, Marc
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Newcombe, Virgin ...
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Menon, David K.
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Brorsson, Camill ...
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Oresic, Matej, 1 ...
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, en Glocker
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Koskinen, Lars-O ...
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Örebro universitet
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