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Observational Study
. 2021 Jun;16(4):1061-1070.
doi: 10.1007/s11739-020-02576-w. Epub 2021 Jan 1.

Predictors of post-traumatic complication of mild brain injury in anticoagulated patients: DOACs are safer than VKAs

Affiliations
Observational Study

Predictors of post-traumatic complication of mild brain injury in anticoagulated patients: DOACs are safer than VKAs

Alessandro Cipriano et al. Intern Emerg Med. 2021 Jun.

Abstract

Although mild traumatic brain injury (MTBI) in people on oral anticoagulant treatment (OAT) is a frequent challenge for Emergency Department (ED), strong guidelines recommendations are lacking. In the attempt to assess the safety profile of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs), we have recruited 473 patients with a MTBI on OAT (43.6% males; age 81.8 ± 8.7 years), admitted to the Pisa's University Hospital ED (Jan 2016-Oct 2018). All patients underwent a head CT scan with those with no sign of acute bleedings remaining under clinical observation for the ensuing 24 h. Fifty patients (10.6%, 95% CI: 8.1-13.7%) had immediate intracranial hemorrhage (ICH), with a prevalence of patient-important outcomes due to immediate ICH of 1.1% (95% CI 0.4-2.4%); 3 patients died (0.6%, 95% CI 0.2-1.8) and 2 required neurosurgical intervention. Immediate ICHs were more frequent in VKA-treated than in DOAC-treated patients (15.9 vs. 6.4%. RR 2.5. 95%CI 1.4-4.4. p < 0.05). Multivariate analysis identified that post-traumatic amnesia, evidence of trauma above clavicles, high blood glucose, high blood pressure (BP) at arrival, and low prothrombin activity were predictors of immediate ICH. The prevalence of delayed ICH was 1.0% (95%CI 0.4-2.5%) without differences between DOACs and VKAs. Despite ICH being a frequent complication of MTBI in patients on OAT, immediate and delayed patient-important outcomes are rare. DOACs have a better safety profile than VKAs. Simple clinical parameters such as blood pressure at arrival or blood glucose might provide useful predictors of immediate ICH.Trial registration number: 11924_CIPRIANO. Local ethics committee approval number 33096.

Keywords: Anticoagulation; Direct oral anticoagulants; Intracranial hemorrhage; Mild traumatic brain injury.

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References

    1. American College of Surgeons' Committee on Trauma (2018) Head trauma: advanced trauma life support, student course manual, 10th edn, pp 109–111
    1. Losoi H, Silverberg ND, Waljas M et al (2016) Recovery from mild traumatic brain injury in previously healthy adults. J Neurotrauma 33:766–776 - PubMed
    1. Borg J, Holm L, Cassidy JD et al (2004) Diagnostic procedures in mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 36:61–75
    1. Dossett LA, Riesel JN, Griffin MR, Cotton BA (2011) Prevalence and implications of preinjury warfarin use: an analysis of the National Trauma Databank. Arch Surg 146:565–570 - PubMed
    1. Pieracci FM, Eachempati SR, Shou J et al (2007) Use of long-term anticoagulation is associated with traumatic intracranial hemorrhage and subsequent mortality in elderly patients hospitalized after falls: analysis of the New York State Administrative Database. J Trauma 63:519–524 - PubMed

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