Comparison of Traumatic Intracranial Hemorrhage Expansion and Outcomes Among Patients on Direct Oral Anticoagulants Versus Vitamin k Antagonists.
Accidental Falls
Aged
Aged, 80 and over
Anticoagulants
/ adverse effects
Antifibrinolytic Agents
/ therapeutic use
Antithrombins
/ adverse effects
Blood Coagulation Factors
/ therapeutic use
Coagulants
/ therapeutic use
Dabigatran
/ adverse effects
Disease Progression
Factor Xa Inhibitors
/ adverse effects
Female
Glasgow Outcome Scale
Humans
Intracranial Hemorrhage, Traumatic
/ chemically induced
Length of Stay
Male
Middle Aged
Mortality
Neurosurgical Procedures
Plasma
Platelet Transfusion
Pyrazoles
/ adverse effects
Pyridines
/ adverse effects
Pyridones
/ adverse effects
Retrospective Studies
Rivaroxaban
/ adverse effects
Thiazoles
/ adverse effects
Vitamin K
/ therapeutic use
Warfarin
/ adverse effects
Apixaban
Dabigatran
Direct oral anticoagulant
Intracerebral hemorrhage
Novel oral anticoagulant
Rivaroxaban
TBI
Traumatic brain injury
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
pubmed:
9
2
2020
medline:
11
2
2021
entrez:
9
2
2020
Statut:
ppublish
Résumé
With increasing use of direct oral anticoagulants (DOACs) and availability of new reversal agents, the risk of traumatic intracranial hemorrhage (tICH) requires better understanding. We compared hemorrhage expansion rates, mortality, and morbidity following tICH in patients treated with vitamin k antagonists (VKA: warfarin) and DOACs (apixaban, rivaroxaban, dabigatran). Retrospective chart review of patients from 2010 to 2017 was performed to identify patients with imaging diagnosis of acute traumatic intraparenchymal, subdural, subarachnoid, and epidural hemorrhage with preadmission use of DOACs or VKAs. We identified 39 patients on DOACs and 97 patients on VKAs. Demographic information, comorbidities, hemorrhage size, and expansion over time, as well as discharge disposition and Glasgow Outcome Scale (GOS) were collected. Primary outcome was development of new or enlargement of tICH within the first 48 h of initial CT imaging. Of 136 patients with mean (SD) age 78.7 (13.2) years, most common tICH subtype was subdural hematoma (N = 102/136; 75%), and most common mechanism was a fall (N = 130/136; 95.6%). Majority of patients in the DOAC group did not receive reversal agents (66.7%). Hemorrhage expansion or new hemorrhage occurred in 11.1% in DOAC group vs. 14.6% in VKA group (p = 0.77) at a median of 8 and 11 h from initial ED admission, respectively (p = 0.82). Patients in the DOAC group compared to VKA group had higher median discharge GOS (4 vs. 3 respectively, p = 0.03), higher percentage of patients with good outcome (GOS 4-5, 66.7% vs. 40.2% respectively, p = 0.005), and higher rate of discharge to home or rehabilitation (p = 0.04). We report anticoagulation-associated tICH outcomes predominantly due to fall-related subdural hematomas. Patients on DOACs had lower tICH expansion rates although not statistically significantly different from VKA-treated patients. DOAC-treated patients had favorable outcomes versus VKA group following tICH despite low use of reversal strategies. DOAC use may be a safer alternative to VKA in patients at risk of traumatic brain hemorrhage.
Sections du résumé
BACKGROUND
With increasing use of direct oral anticoagulants (DOACs) and availability of new reversal agents, the risk of traumatic intracranial hemorrhage (tICH) requires better understanding. We compared hemorrhage expansion rates, mortality, and morbidity following tICH in patients treated with vitamin k antagonists (VKA: warfarin) and DOACs (apixaban, rivaroxaban, dabigatran).
METHODS
Retrospective chart review of patients from 2010 to 2017 was performed to identify patients with imaging diagnosis of acute traumatic intraparenchymal, subdural, subarachnoid, and epidural hemorrhage with preadmission use of DOACs or VKAs. We identified 39 patients on DOACs and 97 patients on VKAs. Demographic information, comorbidities, hemorrhage size, and expansion over time, as well as discharge disposition and Glasgow Outcome Scale (GOS) were collected. Primary outcome was development of new or enlargement of tICH within the first 48 h of initial CT imaging.
RESULTS
Of 136 patients with mean (SD) age 78.7 (13.2) years, most common tICH subtype was subdural hematoma (N = 102/136; 75%), and most common mechanism was a fall (N = 130/136; 95.6%). Majority of patients in the DOAC group did not receive reversal agents (66.7%). Hemorrhage expansion or new hemorrhage occurred in 11.1% in DOAC group vs. 14.6% in VKA group (p = 0.77) at a median of 8 and 11 h from initial ED admission, respectively (p = 0.82). Patients in the DOAC group compared to VKA group had higher median discharge GOS (4 vs. 3 respectively, p = 0.03), higher percentage of patients with good outcome (GOS 4-5, 66.7% vs. 40.2% respectively, p = 0.005), and higher rate of discharge to home or rehabilitation (p = 0.04).
CONCLUSIONS
We report anticoagulation-associated tICH outcomes predominantly due to fall-related subdural hematomas. Patients on DOACs had lower tICH expansion rates although not statistically significantly different from VKA-treated patients. DOAC-treated patients had favorable outcomes versus VKA group following tICH despite low use of reversal strategies. DOAC use may be a safer alternative to VKA in patients at risk of traumatic brain hemorrhage.
Identifiants
pubmed: 32034657
doi: 10.1007/s12028-019-00898-y
pii: 10.1007/s12028-019-00898-y
doi:
Substances chimiques
Anticoagulants
0
Antifibrinolytic Agents
0
Antithrombins
0
Blood Coagulation Factors
0
Coagulants
0
Factor Xa Inhibitors
0
Pyrazoles
0
Pyridines
0
Pyridones
0
Thiazoles
0
Vitamin K
12001-79-5
prothrombin complex concentrates
37224-63-8
apixaban
3Z9Y7UWC1J
Warfarin
5Q7ZVV76EI
Rivaroxaban
9NDF7JZ4M3
anti-inhibitor coagulant complex
CS849DUN3M
Dabigatran
I0VM4M70GC
edoxaban
NDU3J18APO
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
407-418Subventions
Organisme : NINDS NIH HHS
ID : 5U01NS062851
Pays : United States
Organisme : NINDS NIH HHS
ID : 1U01NS080824
Pays : United States
Commentaires et corrections
Type : CommentIn
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