308 - Effect of Antiplatelet Therapy and DDAVP® on Progression of Traumatic Brain Injury in Older Patients
Thursday, May 14, 2020
3:40 PM – 3:48 PM
Location: Capitol: Terrace Level
Participants should be aware of the following financial/non-financial relationships:
Catsim Fassassi: No financial relationships or conflicts of interest
Ronald Simon: No disclosure data submitted.
Heath Walden: No disclosure data submitted.
Krishan Patel: No disclosure data submitted.
Gerard Betro: No disclosure data submitted.
Mehr Qureshi: No disclosure data submitted.
Sergey Motov, MD: No disclosure data submitted.
Richard Savel: No disclosure data submitted.
Jefferson Drapkin, MPH: No disclosure data submitted.
Background and Objectives: The management of elderly on antiplatelet therapy (APT) following traumatic brain injury (TBI) is important. Debate persists concerning use of APT, outcome and type of APT reversal agent (platelet, DDAVP) to use. Our objectives were to examine the impact of APT on progression of TBI; and the effect of DDAVP use on TBI progression in older patients on APT.
Methods: A three-year retrospective review of patients: age ≥65 admitted to a Level 1 Trauma Center diagnosed with TBI and not receiving anticoagulation (NOAC, Warfarin). Patients were divided into those on APT and not (nAPT); only patients with a repeat head CT were included. Data collected: demographics, home medications, mechanism and morphology of injury, Head AIS, ISS and hospital mortality.
Results: 207 patients met criteria. Intracranial injuries were: epidural (1), SAH (50), hemorrhagic contusion (5), subdural (74), mixed (113), intra-parenchymal hematoma (8) and intra-ventricular blood (2). Most common mechanisms of injury was falls (89.3%). Mean Head AIS was 3.2. 113 were on APT and 94 on nAPT. Overall, repeat CT showed progression in 69 (33%) while 138 (66.7%) had no progression. The rate of progression in the nAPT group was 30%. Progression for those on APT was 36% (p=0.32). Progression in those on APT not given DDAVP was 38% vs 34% in those given DDAVP (p=.63). There was no difference in progression between those with nAPT vs those on APT whether given DDAVP or not (p=.54).
Conclusion: Ours is the largest single center study looking at the impact of APT and DDAVP on the progression of TBI in older patients. APT use was not associated with increased TBI progression. DDAVP use did not appear to confer a benefit in those on APT. Our data suggests that APT may not promote the progression of TBI in older patients. Therefore, it is not surprising that APT reversal with DDAVP confers no benefit. The role of DDAVP in TBI should be evaluated in a larger prospective trial.