LAUSR

BACKGROUND Falls are the leading cause of TBI and TBI-related deaths for older persons (age>65). Antiplatelet and/or anticoagulant therapy (antithrombotics, ATs) is generally felt to increase this risk, but the literature is inconsistent. The purpose of this study was to determine the impact of AT use on the rate, severity and outcomes of TBI in older patients following GLFs. METHODS GLF patients from 90 hospitals' trauma registries were selected. Patients were excluded if <65 years or had an AIS > 2 in a region other than head. EMR data for preinjury AT therapy were obtained. Patients were grouped by regimen for no AT, single, or multiple agents. Groups were compared on rates of diagnosed TBI, TBI surgery, and mortality. RESULTS There were 33 710 patients (35% male, mean age 80.5, mean GCS 14.6), with 47.6% on single or combination AT therapy. The proportion of patients with TBI diagnoses did not differ between those on No AT (21.25%) vs AT (21.61%; P=.418). Apixaban (15.7%; P<.001) and Rivaroxaban (13.19%; P=.011) were associated with lower rates of TBI, and ASA + Clopidogrel was associated with a higher TBI rate (24.34%; P=.002) vs. No AT. ASA + Clopidogrel was associated with a higher cranial surgery rate (2.9%; P=.006) vs No AT (1.96%), but surgery rates were similar for all other regimens. No regimen was associated with higher mortality. CONCLUSIONS In this large, multicenter study, the intake of ATs in older patients with GLFs was associated with inconsistent effects on risk of TBI and no significant increases in mortality, indicating AT use may have negligible impact on patient clinical management. A large, confirmatory, prospective study is needed, as the commonly held belief that ATs uniformly increase the risk of traumatic intracranial bleeding and mortality is not supported. LEVEL OF EVIDENCE Level II (therapeutic/care management).