New Analysis Highlights Thromboelastography as a Potential Bleed Risk Tool for Elderly Patients With TBI
For elderly patients presenting to the emergency department with a traumatic brain injury (TBI), a thromboelastography (TEG) test can likely predict the effects of anticoagulant or antiplatelet therapy, according to new data presented at the American College of Emergency Physicians 2021 Annual Meeting.
To conduct their study, the researchers included all patients aged 65 years or older who had presented with an acute TBI to 2 US-based trauma centers (N = 430). All patients included in the analysis had had a TEG conducted. A chart review revealed patients taking anticoagulant therapy (n = 97) and antiplatelet therapy (n = 159) before the head injury had occurred.
Compared with patients taking no anticoagulant or antiplatelet therapies:
- Patients taking aspirin had a significantly higher percentage inhibition of arachidonic acid and lower maximum amplitude of arachidonic acid.
- Patients taking a P2Y12 inhibitor had a significantly higher maximum amplitude, higher percentage inhibition of adenosine diphosphate, and lower maximum amplitude of adenosine diphosphate.
- Patients taking warfarin had a significantly higher reaction time, lower percentage inhibition of arachidonic acid, and higher maximum amplitude of arachidonic acid.
- Patients taking a factor Xa inhibitor had a significantly higher reaction time, lower percentage inhibition of arachidonic acid, and higher maximum amplitude of adenosine diphosphate.
- Patients taking dabigatran or heparin had no significant differences.
“TEG assays are increasingly being used to assess coagulation function in head injury patients in the emergency department,” the researchers wrote. “Our study shows that in a geriatric population who sustained TBIs, abnormal TEG values may be used to help determine which antiplatelet or anticoagulant medications a patient might have taken. In turn, this can help guide reversal agent treatment, which may lead to better outcomes.”
Solano J, Clayton L, Hughes P, Shih R, Alter S. Thromboelastography may help identify anticoagulant or antiplatelet effects in geriatric traumatic brain injury patients. Paper presented at: American College of Emergency Physicians 2021; October 25-28, 2021; Virtual. https://www.annemergmed.com/article/S0196-0644(21)00876-3/fulltext