Benefits and Risks of Anticoagulation Resumption Following Traumatic Brain Injury

作者：Jennifer S. Albrecht, Xinggang Liu, Mona Baumgarten, Patricia Langenberg, Gail B. Rattinger, Gordon S. Smith, Steven Gambert, Stephen S. Gottlieb, Ilene H. Zuckerman · 发表于：JAMA Internal Medicine · 年份：2014 · DOI：10.1001/jamainternmed.2014.2534 · 被引用次数：75 · 研究领域：Traumatic Brain Injury and Neurovascular Disturbances、Blood Coagulation and Thrombosis Mechanisms、S100 Proteins and Annexins

IMPORTANCE: The increased risk of hemorrhage associated with anticoagulant therapy following traumatic brain injury creates a serious dilemma for medical management of older patients: Should anticoagulant therapy be resumed after traumatic brain injury, and if so, when? OBJECTIVE: To estimate the risk of thrombotic and hemorrhagic events associated with warfarin therapy resumption following traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of administrative claims data for Medicare beneficiaries aged at least 65 years hospitalized for traumatic brain injury during 2006 through 2009 who received warfarin in the month prior to injury (n = 10,782). INTERVENTION: Warfarin use in each 30-day period following discharge after hospitalization for traumatic brain injury. MAIN OUTCOMES AND MEASURES: The primary outcomes were hemorrhagic and thrombotic events following discharge after hospitalization for traumatic brain injury. Hemorrhagic events were defined on inpatient claims using International Classification of Diseases, Ninth Revision, Clinical Modification codes and included hemorrhagic stroke, upper gastrointestinal bleeding, adrenal hemorrhage, and other hemorrhage. Thrombotic events included ischemic stroke, pulmonary embolism, deep venous thrombosis, and myocardial infarction. A composite of hemorrhagic or ischemic stroke was a secondary outcome. RESULTS: Medicare beneficiaries with traumatic brain injury were predominantly female (64%) and whi...