Will the bleeding stop? A commentary on: Effect of anticoagulation on isolated traumatic brain injury mortality using TQIP database: a propensity score analysis stratified by head injury severity

Traumatic brain injury (TBI) continues to represent a major source of trauma-related morbidity and mortality in the USA, accounting for nearly one-third of all injury deaths. The growing proportion of elderly patients, many chronically anticoagulated for atrial fibrillation, venous thromboembolism, or prosthetic valves, poses a growing clinical challenge. The study by Kulvatunyou et al provides an important, large-scale contribution to this topic by examining the effect of preinjury anticoagulation (AC) on mortality after isolated TBI. Using data from the ACS-TQIP (American College of Surgeons Trauma Quality Improvement Program) database, the authors performed a propensity score matched analysis of nearly 97 000 patients over age 50, stratified by head injury severity.