Coagulopathy, injury severity and bleeding progression but not prior antiplatelet and anticoagulation therapies drive prognosis in patients with moderate to severe traumatic brain injury.

Introduction: Antiplatelet and anticoagulant therapies complicate the management and outcomes of traumatic brain injury (TBI) patients. This study evaluates clinical profiles and short-term outcomes focusing on prior antihemostatic therapy and tranexamic acid (TXA) use.

Patients And Methods: We analyzed TBI patients admitted to University Hospital Frankfurt (2018-2021), assessing demographics, injury characteristics, clinical course, and short-term outcomes. The primary endpoint was hemorrhage progression; secondary endpoints included the modified Rankin Scale (mRS) at discharge, mortality and thromboembolic complications. Regression models identified predictors of functional outcome and mortality.

Results: Among 218 patients (median age 70 years, 35% female, median GCS at admission 7), 44% had prior antiplatelet or anticoagulation therapy. These patients were older, had higher pre-injury mRS scores, and more often sustained TBIs from falls. While hemorrhage progression was similar, they had worse mRS scores ( = 0.02) and higher mortality ( = 0.002). Coagulopathy (OR 1.11, CI 1.07-1.16,  < 0.001), injury severity (OR 2.25, CI 1.51-3.41,  < 0.001), and bleeding progression (OR 2.23, CI 1.48-3.41,  < 0.001) predicted poor functional outcomes. TXA was more often given to younger, severely injured patients but did not impact outcome.

Conclusion: This study underscores the need for tailored therapeutic approaches to improve survival and functional recovery in patients with pre-injury antiplatelet and anticoagulant therapies.