84 Morbidity and Mortality in Elderly Head Injured Patients on Pre-Injury Antithrombotics: A Systematic Review

Objectives The main objectives of this systematic review were to synthesize the available research on outcomes in elderly patients who had experienced traumatic brain injury while using antithrombotic therapy (ATT) to determine the difference in outcome compared to non-use as well as compare outcomes in different ATT types. Design A systematic review whose protocol is on the International prospective register of systematic reviews (PROSPERO). The review included all English language studies conducted between 2000 and 2021. Subjects All studies which evaluated mortality (at any time point following the injury) and morbidity in all anticoagulated head-injured patients > 64 years. Method We searched all the major databases that index biomedical journals for articles that fit the inclusion criteria using pre-piloted search terms. Study screening for inclusion was done using Covidence®. Data were extracted into Excel and quality assessment was done with the ROBINS-I tool. Results 15 of 5,644 studies, all of which were conducted in high-income countries, were included. The estimated odds of mortality were 2.32 (1.66–3.25) in favour of non-use of ATT. Mortality rates were 2–38% versus 0–23% in the ATT versus non-ATT groups respectively. There were significantly higher odds of mortality with VKA use– up to 5.18 vs 1.60 with other ATT agents. The odds of mortality were higher among individuals with therapeutic INR – 4.48 versus 1.28. Morbidity was worse with ATT use compared to non-ATT use. Conclusions Outcomes in head-injured elderly patients seem to be worse with the use of certain ATT agents—especially VKAs compared to other ATT groups.