Ryan C Lovell, Jeffry Nahmias, Peter D Nguyen, Michael Lekawa, Sigrid Burruss, Patrick Chen, Jefferson Chen, Areg Grigorian
Preinjury anticoagulation in OATPs was independently associated with severe TBI and mortality. While anticoagulation remains important for thromboembolic prevention, these findings highlight substantial risk in a fall-prone aging population. Re-evaluation of geriatric anticoagulation guidelines to better balance thromboembolic protection with trauma-related risk appears warranted.
INTRODUCTION: Ground-level falls (GLFs) are a leading cause of morbidity and mortality in older adults, a population frequently prescribed anticoagulants. While effective for thromboembolic prevention, the association between anticoagulation and fall-related complications, including traumatic brain injury (TBI), remains mixed, with prior studies reporting inconsistent findings. This study utilized a large national database to evaluate whether preinjury anticoagulation is associated with worse outcomes following GLFs, hypothesizing increased mortality and severe TBI in anticoagulated versus nonanticoagulated older adults.
METHODS: The 2017-2022 Trauma Quality Improvement Program database was queried for older adult trauma patients (OATPs) (≥65 y) presenting after GLFs. Patients were stratified by anticoagulant use. Bivariate analyses and multivariable logistic regression assessed associations with TBI severity and inhospital mortality.
RESULTS: Among 1,062,072 OATPs, 300,623 (28.3%) were on anticoagulation. Anticoagulated patients had higher rates of mild (21.1% versus 14.0%, P < 0.001), moderate (13.2% versus 11.9%, P < 0.001), and severe TBI (4.9% versus 2.8%, P < 0.001). They more frequently required the highest-level trauma activation (2.4% versus 1.5%, P < 0.001) and had higher complication (6.4% versus 4.5%, P < 0.001) and mortality rates (4.3% versus 2.5%, P < 0.001). Anticoagulation was independently associated with mortality (OR 1.34, CI 1.31-1.37, P < 0.001) and TBI severity, from mild (OR 1.64, CI 1.62-1.65, P < 0.001) to severe TBI (OR 1.80, CI 1.76-1.84, P < 0.001).
CONCLUSIONS: Preinjury anticoagulation in OATPs was independently associated with severe TBI and mortality. While anticoagulation remains important for thromboembolic prevention, these findings highlight substantial risk in a fall-prone aging population. Re-evaluation of geriatric anticoagulation guidelines to better balance thromboembolic protection with trauma-related risk appears warranted.