1262 Prevalence of Inappropriate Antithrombotic Use in Elderly Patients With Traumatic Brain Injury

INTRODUCTION: Antithrombotic (AT) use among geriatric population (=65 years) has been associated with worse outcomes after traumatic brain injury (TBI). Previous studies have found that use of AT outside of established guideline is widespread in the general population and TBI patients. METHODS: We retrospective reviewed charts of geriatric TBI patients with preinjury AT use from 2016 and 2023. Patient demographics, AT indications/types, and post-injury outcomes were extracted. The appropriateness of AT use was determined using established clinical guidelines. RESULTS: Our cohort consisted of 145 patients (43.4% females, 56.6% males; mean age 79±7 years). Fall was the most common mechanism of injury (88.3%). 84.8% patients were classified to have mild TBI (GCS 13-15) on initial presentation. Two most common indications for AT included atrial fibrillation (41.1%) and venous thromboembolism (VTE) (20.7%). 45.5% of patients were on an anticoagulant, 41.4% on an antiplatelets, and 13.1% were on both. Prescribed AT agents included warfarin (27.6%), direct oral anticoagulants (30.3%), aspirin (35.2%), and clopidogrel (18.6%). Following clinical guidelines, 16.6% of the patients were deemed inappropriately on AT therapy. On multivariate analysis, VTE indication (OR 3.71, 95% CI 1.33-10.33, p=0.012) and aspirin use (OR 3.31, 95% CI 3.314-27.4, p=<0.001) were associated with inappropriate AT use. Outcomes (length of stay, disposition, and 30-day mortality) following TBI were not significantly different between patients who were appropriately or inappropriately on AT. CONCLUSIONS: Sixteen percent of geriatric TBI patients were observed to be inappropriately consuming AT medications. The most common diagnosis was history of VTE. Aspirin was the most common medication inappropriately used. While the inappropriate utilization of ATs did not result in worsened outcomes in our cohort, further consideration of the implications of polypharmacy in the geriatric population is warranted.