Study On Risk Factors Of Traumatic Brain Injury Using Antithrombotic Drugs Before Injury

Objective:With the increasing incidence of cardiovascular and cerebrovascular diseases,the proportion of people using antithrombotic drugs is also increasing.When traumatic brain injury(TBI)occurred in this population,the factor of using antithrombotic drugs may have a negative impact on their disease progression and prognosis.The application of antithrombotic drugs not only aggravates the progression of craniocerebral trauma,but also affects the judgment of strategies for reversing antithrombotic drugs in patients undergoing emergency surgery.The reversal agent of antithrombotic drugs can improve the coagulation state of patients,avoid the continuous effect of antithrombotic drugs on the coagulation system,and then reduce the amount of blood loss in trauma patients.The peculiarity of cardiovascular function in TBI patients receiving antithrombotic drugs poses great challenges to clinical management and emergency surgery.This study is expected to analyze the risk factors of TBI patients who received oral antithrombotic drugs before injury,so as to clarify the impact of different types of antithrombotic drugs on the death of TBI patients,so as to reduce the mortality of the reorganized population.Methods:The hospitalized patients with simple TBI who met the screening conditions from January 1,2019 to January 1,2022 in our hospital were collected for retrospective analysis.Among them,35 TBI patients received oral antiplatelet drugs and 33 patients received oral vitamin K antagonists;Age,gender,past history and other information of TBI patients without oral antithrombotic drugs were used to match TBI patients with oral antithrombotic drugs.A total of 39 TBI patients without prior use of antithrombotic drugs were selected and divided into survival and death groups according to the survival outcome of patients.Collect various clinical information of patients,including general information: age,sex,past history,and history of concomitants,etc.,disease assessment,progress and laboratory indicators include: Severity of TBI(GCS score),related laboratory indicators(blood cell analysis,liver function,renal function,coagulation series),clinically relevant treatment options(whether cranial operation or not),average length of stay,whether death and other information.According to the collected clinical information,univariate analysis was performed to identify statistically significant factors(P<0.05),and then statistically significant factors were included in multivariate analysis to study the risk factors for poor prognosis in TBI patients with oral antithrombotic drugs.Results:In this study,68 of 107 patients with simple craniocerebral injury had oral history of antithrombotic drugs before injury.Among them,the single factor analysis results: coronary heart disease,hospitalization days,TBI severity(GCS score),mechanical ventilation,pupillary response,high cranial pressure,cranial operation,ICU admission,the types of oral antithrombotic drugs,blood coagulation series(PT,APTT,INR,D-dimer)for a total of 13 kinds of factors in comparison there is statistical significance between groups(i.e.,P < 0.05),indicating that the death of TBI patients may be affected by these 13 factors.After the 13 single factors with statistical significance were included in the multivariate logistic regression analysis,the results showed that: a total of 4 risk factors may work together to cause the death of TBI patients;The four factors were: short length of stay,high degree of TBI injury(low GCS score),high cranial pressure and oral vitamin K antagonist before injury;Among them,the factor of average length of stay is a protective factor,that is,TBI patients with a better prognosis have a longer length of stay,which is considered to be caused by the increased length of stay caused by the patient’s primary disease.Conclusion:The severity of TBI,coronary heart disease,length of hospital stay,mechanical ventilation,pupil reaction,high cranial pressure,craniocerebral surgery,admission to ICU,types of oral antithrombotic drugs,clotting series(PT,APTT,INR,D-dimer)and other factors are independent risk factors that may affect the clinical outcome of TBI patients,namely death.TBI patients with a history of oral antithrombotic drugs had an increased risk of death compared with ordinary TBI patients.Among them,patients with oral vitamin K antagonists had the highest risk of death(OR=2.800),while patients with antiplatelet drugs had no significant increased risk of death(OR=1.025).Therefore,early anticoagulation reversal of TBI patients with oral vitamin K antagonists is an effective method to reduce the mortality of TBI patients in this group.