258 Impact of Risk Stratified Antithrombotic Medication Resumption After Traumatic Brain Injury on Patient Outcomes

INTRODUCTION: The incidence of traumatic brain injury (TBI) in patients on antithrombotic (AT) medications to prevent thromboembolic events is increasing. AT medications include antiplatelets and/or anticoagulants. While these medications are generally stopped in the setting of intracranial bleed, the optimal medication resumption time is uncertain. Both brief and prolonged suspension carry risk. In March 2021 we adjusted our institutional guidelines from restarting AT therapy at two weeks or more after TBI to resuming medications based on patient risk factors. METHODS: We performed a retrospective case-control study of data from the University of Cincinnati Level 1 Trauma Center neurotrauma registry between February 2017-November 2022. Patients on AT therapy presenting with intracranial hemorrhage and a Glasgow Coma Scale (GCS) score of 13-15 were included. The LR cohort included patients from February 2017-December 2019. The RSR cohort included patients from March 2021-November 2022. Demographics, injury variables, medication history, medication resumption, and thrombotic or hemorrhagic events up to 6 months after injury were collected. Groups were compared using t-tests for linear variables and Chi-Square for categorical variables with p < 0.05 denoted as significant. RESULTS: We identified 406 patients with 337 patients in the LR cohort and 69 patients in the RSR cohort. Early resumption (during hospitalization) occurred in 21.7% of the RSR cohort compared to 9.5% in the LR group. The difference in occurrence of thrombotic and hemorrhagic events between groups was not significant. CONCLUSIONS: Resuming antithrombotic medications after a TBI based on risk stratification criteria allows earlier resumption of medication with no associated increase in thrombotic or hemorrhagic events.