The risk of stroke for patients with traumatic brain injury is highest in the four months after the injury and remains significant for up to five years after the injury, finds a new systematic review led by a team from the University of Birmingham.
Traumatic brain injury (TBI) is a global health problem that affects over 60 million people a year worldwide. Incidences of TBI are rising due to a number of factors, including an increased decline in the elderly, military conflicts, sports injuries and car accidents. However, advances in critical care and imaging have led to a reduction in TBI-related mortality.
Previous studies have linked TBI to the long-term risk of neurological diseases, including dementia, Parkinson’s disease, and epilepsy, and TBI has been proposed as an independent risk factor for stroke.
This latest review, which brings together 18 studies from four countries and is published today (April 9) in International Journal of Stroke, is the first of its kind to investigate the risk of stroke after injury.
The review, funded by the Research Center for Surgical Reconstruction and Microbiology of the National Institute for Health Research based at Birmingham University Hospitals NHS Foundation Trust, found that patients with TBI had an 86% increased risk of stroke compared to patients who did not experience TBI. The risk of stroke may be highest in the first four months after the injury, but it remains significant for up to five years, research has shown.
Significantly, the findings suggest that TBI is a risk factor for stroke regardless of severity or subtype of injury. This is particularly noteworthy because 70% to 90% of TBI is mild and suggests that TBI should be considered a chronic condition, even if it is mild and if patients are recovering well.
Researchers have also found that the use of anticoagulants, such as VKA and statins, could help reduce the risk of stroke after TBI, while the use of some classes of antidepressants is associated with an increased risk of stroke after TBI.
Stroke is the second leading cause of death and the third leading cause of disability in the world, however, emergency treatment can prevent death due to stroke and long-term disability. Our review found some evidence to suggest an association between reduced risk of stroke after TBI and VKA and stroke prevention drugs and statins, but, as previous studies have found, stroke prevention drugs often stop when an individual experiences TBI. . “
Dr Grace Turner, lead author, Institute for Applied Health Research, University of Birmingham
She said more research is needed to examine the effectiveness of stroke prevention drugs after TBI to help inform prescribing clinicians and facilitate joint decision-making.
As our review has shown, patients with TBI should be informed of the potential for an increased risk of stroke, and with the highest risk of stroke in the first four months after injury, this is a critical time period for educating patients and their caregivers about the risk from stroke and symptoms. This initial four-month period should also be used by clinicians to provide stroke prevention medications and lifestyle advice to alleviate the excessive risk of stroke associated with TBI. “
Dr. Grace Turner