(1558) Venous Sinus Thrombosis and Traumatic Brain Injury: Is Anticoagulation Safe?

Tuesday, January 23, 2024

11:15 AM – 12:15 PM MT

Location: Connections Central - RST 06

First Author(s)

Lee Fuentes, MBA (he/him/his)

n/a

Co-Author(s)

JH

Jason Hutzler, MD

Resident Physician
University of Texas at Austin Dell Medical School, United States
SP

Stephan Pan, MD

Physician
University of Texas at Austin Dell Medical School, United States
JD

Joseph DuBose, MD

Professor
Dell Medical School, University of Texas, United States
PT

Pedro Teixeira, MD

Physician
University of Texas at Austin Dell Medical School, United States
CB

Carlos Brown, MD

Physician
University of Texas at Austin Dell Medical School, United States
JA

Jayson Aydelotte, MD

Associate Professor
Dell Medical School, University of Texas, United States

Introduction: Patients with traumatic brain injury (TBI) and concomitant venous sinus thrombosis (VST) present a traditionally difficult decision matrix. No guidelines exist with data driven recommendations on how to manage this situation. We hypothesize that therapeutically anticoagulating patients with concomitant TBI and VST will worsen intracranial bleeding and lead to worse outcomes.

Methods: This is a single-center retrospective review of treatments and outcomes for all trauma patients with both TBI and VST from 2017 – 2022 at our academic, level 1 trauma center. Patients were divided into two groups, those that received therapeutic anticoagulation started and those that did not. The primary outcome was in-hospital mortality. Secondary outcome was worsening radiographic findings after starting therapeutic anticoagulation. All patients' radiographic data were independently reviewed by a blinded radiologist.

Results: There were 20 patients with concomitant TBI and VST injuries identified and analyzed. Ten (50%) patients received therapeutic anticoagulation while 10 (50%) did not receive therapeutic anticoagulation during this time. There were no significant differences between the demographics, types of TBI, and types/locations of VST of these two groups. The therapeutic anticoagulation patients were all treated with a heparin infusion. Of the other ten patients, three did not receive any anticoagulation at all, and 7 received aspirin (81mg) only. There was no significant difference in in-hospital mortality between no anticoagulation and anticoagulation groups, respectively (30% vs 20% p=0.63). The group that did not receive therapeutic anticoagulation actually had a higher rate of radiographic progression of TBI (71% vs. 0%, p< 0.001).

Conclusions: The use of therapeutic anticoagulation of VST in patients with concomitant TBI was not associated with radiographic worsening of TBI or mortality.