Study Reveals Impact of Anticoagulation on Traumatic Brain Injuries

In the realm of neurosurgical care, traumatic brain injuries with acute subdural hematoma are a common occurrence, especially as demographics shift towards an aging population. The landscape of trauma is evolving, with low-impact injuries leading to acute-on-chronic subdural hemorrhages becoming more prevalent than high-velocity trauma mechanisms. To delve into the impact of perioperative prophylactic anticoagulation (AC) on morbidity, mortality, and complications post-neurosurgical treatment, a retrospective analysis was conducted on 259 patients with severe traumatic brain injuries and subsequent subdural hematomas between 2014 and 2019.

The study focused on the timing of AC administration and its relation to adverse events, particularly postoperative intracranial hemorrhage (PH) and thromboembolic events (TE). The data revealed that while TE occurrences were relatively rare, PH was more common, with a subset requiring surgical intervention. Interestingly, a delay in AC was correlated with PH, suggesting a deliberate postponement of AC following a hemorrhage event. However, early prophylactic AC did not show a significant correlation with either PH or TE.

Notably, only a small number of patients were on AC before experiencing PH, indicating that the majority received AC post-hemorrhage. This timeline emphasized the lack of causality between AC administration and PH events. Patients who suffered from PH were more likely to face mortality within 30 days, underscoring the significance of recurrent intracranial hemorrhage on patient outcomes.

Factors such as preexisting therapeutic AC and clinical signs like preoperative herniation with a dilated pupil were associated with increased risk of PH. In contrast, the size of the hematoma and midline shift did not exhibit significant correlations. The study also highlighted the influence of early surgery on TE occurrences, with a shorter time span to the operating room potentially leading to higher TE rates.

Despite the limitations of the study in establishing causality, the findings provide insights into the role of prophylactic AC in traumatic subdural hematoma cases. The results suggest that timely AC administration did not contribute to PH, with preoperative conditions and clinical status playing a more crucial role in outcomes. Furthermore, the study sheds light on the complexities of balancing AC administration in neurosurgical settings and the need for further research to refine guidelines and practices in this domain.