Bleeding and Thromboembolism After TBI in the Elderly: A Real Conundrum

Nina Glass, Aparna Vadlamani, Franchesca Hwang, Ziad C. Sifri, Anastasia Kunac, Stephanie Bonne, Sri Ram Pentakota, Peter Yonclas, Anne Mosenthal, David Livingston, Jennifer S. Albrecht

Research output: Contribution to journalArticle

Abstract

Background: Elderly patients presenting with a traumatic brain injury (TBI) often have comorbidities that increase risk of thromboembolic (TE) disease and recurrent TBI. A significant number are on anticoagulant therapy at the time of injury and studies suggest that continuing anticoagulation can prevent TE events. Understanding bleeding, recurrent TBI, and TE risk after TBI can help to guide therapy. Our objectives were to 1) evaluate the incidence of bleeding, recurrent TBI, and TE events after an initial TBI in older adults and 2) identify which factors contribute to this risk. Methods: Retrospective analysis of Medicare claims between May 30, 2006 and December 31, 2009 for patients hospitalized with TBI was performed. We defined TBI for the index admission, and hemorrhage (gastrointestinal bleeding or hemorrhagic stroke), recurrent TBI, and TE events (stroke, myocardial infarction, deep venous thrombosis, or pulmonary embolism) over the following year using ICD-9 codes. Unadjusted incidence rates and 95% confidence intervals (CIs) were calculated. Risk factors of these events were identified using logistic regression. Results: Among beneficiaries hospitalized with TBI, incidence of TE events (58.6 events/1000 person-years; 95% CI 56.2, 60.8) was significantly higher than bleeding (23.6 events/1000 person-years; 95% CI 22.2, 25.1) and recurrent TBI events (26.0 events/1000 person-years; 95% CI 24.5, 27.6). Several common factors predisposed to bleeding, recurrent TBI, and TE outcomes. Conclusions: Among Medicare patients hospitalized with TBI, the incidence of TE was significantly higher than that of bleeding or recurrent TBI. Specific risk factors of bleeding and TE events were identified which may guide care of older adults after TBI.

Original languageEnglish (US)
Pages (from-to)615-620
Number of pages6
JournalJournal of Surgical Research
Volume235
DOIs
StatePublished - Mar 1 2019

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Thromboembolism
Hemorrhage
Confidence Intervals
Incidence
Traumatic Brain Injury
International Classification of Diseases
Medicare
Stroke
Insurance Claim Review
Gastrointestinal Hemorrhage
Pulmonary Embolism
Venous Thrombosis
Anticoagulants
Comorbidity

Cite this

Glass, Nina ; Vadlamani, Aparna ; Hwang, Franchesca ; Sifri, Ziad C. ; Kunac, Anastasia ; Bonne, Stephanie ; Pentakota, Sri Ram ; Yonclas, Peter ; Mosenthal, Anne ; Livingston, David ; Albrecht, Jennifer S. / Bleeding and Thromboembolism After TBI in the Elderly : A Real Conundrum. In: Journal of Surgical Research. 2019 ; Vol. 235. pp. 615-620.
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abstract = "Background: Elderly patients presenting with a traumatic brain injury (TBI) often have comorbidities that increase risk of thromboembolic (TE) disease and recurrent TBI. A significant number are on anticoagulant therapy at the time of injury and studies suggest that continuing anticoagulation can prevent TE events. Understanding bleeding, recurrent TBI, and TE risk after TBI can help to guide therapy. Our objectives were to 1) evaluate the incidence of bleeding, recurrent TBI, and TE events after an initial TBI in older adults and 2) identify which factors contribute to this risk. Methods: Retrospective analysis of Medicare claims between May 30, 2006 and December 31, 2009 for patients hospitalized with TBI was performed. We defined TBI for the index admission, and hemorrhage (gastrointestinal bleeding or hemorrhagic stroke), recurrent TBI, and TE events (stroke, myocardial infarction, deep venous thrombosis, or pulmonary embolism) over the following year using ICD-9 codes. Unadjusted incidence rates and 95{\%} confidence intervals (CIs) were calculated. Risk factors of these events were identified using logistic regression. Results: Among beneficiaries hospitalized with TBI, incidence of TE events (58.6 events/1000 person-years; 95{\%} CI 56.2, 60.8) was significantly higher than bleeding (23.6 events/1000 person-years; 95{\%} CI 22.2, 25.1) and recurrent TBI events (26.0 events/1000 person-years; 95{\%} CI 24.5, 27.6). Several common factors predisposed to bleeding, recurrent TBI, and TE outcomes. Conclusions: Among Medicare patients hospitalized with TBI, the incidence of TE was significantly higher than that of bleeding or recurrent TBI. Specific risk factors of bleeding and TE events were identified which may guide care of older adults after TBI.",
author = "Nina Glass and Aparna Vadlamani and Franchesca Hwang and Sifri, {Ziad C.} and Anastasia Kunac and Stephanie Bonne and Pentakota, {Sri Ram} and Peter Yonclas and Anne Mosenthal and David Livingston and Albrecht, {Jennifer S.}",
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Bleeding and Thromboembolism After TBI in the Elderly : A Real Conundrum. / Glass, Nina; Vadlamani, Aparna; Hwang, Franchesca; Sifri, Ziad C.; Kunac, Anastasia; Bonne, Stephanie; Pentakota, Sri Ram; Yonclas, Peter; Mosenthal, Anne; Livingston, David; Albrecht, Jennifer S.

In: Journal of Surgical Research, Vol. 235, 01.03.2019, p. 615-620.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Bleeding and Thromboembolism After TBI in the Elderly

T2 - A Real Conundrum

AU - Glass, Nina

AU - Vadlamani, Aparna

AU - Hwang, Franchesca

AU - Sifri, Ziad C.

AU - Kunac, Anastasia

AU - Bonne, Stephanie

AU - Pentakota, Sri Ram

AU - Yonclas, Peter

AU - Mosenthal, Anne

AU - Livingston, David

AU - Albrecht, Jennifer S.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Elderly patients presenting with a traumatic brain injury (TBI) often have comorbidities that increase risk of thromboembolic (TE) disease and recurrent TBI. A significant number are on anticoagulant therapy at the time of injury and studies suggest that continuing anticoagulation can prevent TE events. Understanding bleeding, recurrent TBI, and TE risk after TBI can help to guide therapy. Our objectives were to 1) evaluate the incidence of bleeding, recurrent TBI, and TE events after an initial TBI in older adults and 2) identify which factors contribute to this risk. Methods: Retrospective analysis of Medicare claims between May 30, 2006 and December 31, 2009 for patients hospitalized with TBI was performed. We defined TBI for the index admission, and hemorrhage (gastrointestinal bleeding or hemorrhagic stroke), recurrent TBI, and TE events (stroke, myocardial infarction, deep venous thrombosis, or pulmonary embolism) over the following year using ICD-9 codes. Unadjusted incidence rates and 95% confidence intervals (CIs) were calculated. Risk factors of these events were identified using logistic regression. Results: Among beneficiaries hospitalized with TBI, incidence of TE events (58.6 events/1000 person-years; 95% CI 56.2, 60.8) was significantly higher than bleeding (23.6 events/1000 person-years; 95% CI 22.2, 25.1) and recurrent TBI events (26.0 events/1000 person-years; 95% CI 24.5, 27.6). Several common factors predisposed to bleeding, recurrent TBI, and TE outcomes. Conclusions: Among Medicare patients hospitalized with TBI, the incidence of TE was significantly higher than that of bleeding or recurrent TBI. Specific risk factors of bleeding and TE events were identified which may guide care of older adults after TBI.

AB - Background: Elderly patients presenting with a traumatic brain injury (TBI) often have comorbidities that increase risk of thromboembolic (TE) disease and recurrent TBI. A significant number are on anticoagulant therapy at the time of injury and studies suggest that continuing anticoagulation can prevent TE events. Understanding bleeding, recurrent TBI, and TE risk after TBI can help to guide therapy. Our objectives were to 1) evaluate the incidence of bleeding, recurrent TBI, and TE events after an initial TBI in older adults and 2) identify which factors contribute to this risk. Methods: Retrospective analysis of Medicare claims between May 30, 2006 and December 31, 2009 for patients hospitalized with TBI was performed. We defined TBI for the index admission, and hemorrhage (gastrointestinal bleeding or hemorrhagic stroke), recurrent TBI, and TE events (stroke, myocardial infarction, deep venous thrombosis, or pulmonary embolism) over the following year using ICD-9 codes. Unadjusted incidence rates and 95% confidence intervals (CIs) were calculated. Risk factors of these events were identified using logistic regression. Results: Among beneficiaries hospitalized with TBI, incidence of TE events (58.6 events/1000 person-years; 95% CI 56.2, 60.8) was significantly higher than bleeding (23.6 events/1000 person-years; 95% CI 22.2, 25.1) and recurrent TBI events (26.0 events/1000 person-years; 95% CI 24.5, 27.6). Several common factors predisposed to bleeding, recurrent TBI, and TE outcomes. Conclusions: Among Medicare patients hospitalized with TBI, the incidence of TE was significantly higher than that of bleeding or recurrent TBI. Specific risk factors of bleeding and TE events were identified which may guide care of older adults after TBI.

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