Traumatic Brain Injury in Older Adults—A Public Health Perspective

Dana Waltzman; Juliet Haarbauer-Krupa; Lindsay S. Womack

doi:10.1001/jamaneurol.2022.0114

Traumatic brain injuries (TBIs) are a leading cause of morbidity and mortality in the US.¹ In recent years, these injuries have received greater attention as a public health concern due to increased awareness of sport- and military-related TBIs.² However, older adults have been reported to have higher rates of TBI than any other age group.¹ In 2017, adults aged 65 years or older accounted for 38.4% of all TBI-related deaths and 43.9% of all TBI-related hospitalizations in the US.¹ In addition, older adults who experience a TBI are more likely to have higher morbidity and mortality, slower recovery, and worse outcomes than younger adults.²

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May 10, 2022

Anti-platelet agents and anti-coagulants as aggravating factors on traumatic brain injury

John Leung, M.B.,B.S.,F.R.C.S.Ed. | St. Paul's Hospital, Hong Kong

Waltzman et al. have issued a timely warning on the importance of traumatic brain injury among the older population especially as this population is increasing in many parts of the world. Their article briefly touched on the aggravating effects of co-morbidities and medications that often accompany the elderlies and complicate their management. In this respect, may I suggest that we pay particular attention to the common practice of taking aspirin for the prevention and treatment of cardiovascular events and (arguably) the prevention of certain cancers. Other anti-platelet agents like clopidogrel, prasugrel and ticagrelor are also often prescribed for vascular problems especially when intravascular stents have been deployed. With atrial fibrillation and deep vein thrombosis, both common events affecting the elderly, anti-coagulants are almost routinely prescribed. The older Warfarin may be fine-tuned by the prothrombin-INR test but its pharmacokinetics respond very slowly to dose adjustment. The novel/direct oral anticoagulants have much faster onset and offset timing but is difficult to monitor or fine tune. The elderly patient put on these medications would be at disproportionately high risk of severe intracranial hemorrhage, and once started such bleeding would be more difficult to stop. Moreover, any attempt to reverse this medically induced bleeding tendency might subject the patient to the risk of the original conditions for which such medications were prescribed. This situation calls for the conjoint effort of multidiscipline management.

CONFLICT OF INTEREST: None Reported

Traumatic Brain Injury in Older Adults—A Public Health Perspective

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