Comparison of Traumatic Intracranial Hemorrhage Expansion and Outcomes Among Patients on Direct Oral Anticoagulants Versus Vitamin k Antagonists
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 v...
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| Veröffentlicht in: | Neurocritical care 2020-04, Vol.32 (2), p.407-418 |
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| description | 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. |
| doi_str_mv | 10.1007/s12028-019-00898-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2919330277</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2919330277</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-9475a464681b524c03a0918dad899aaab5d02ac1529625dc8cb82855245d4c2b3</originalsourceid><addsrcrecordid>eNp9kc1OGzEUha0KVP76Al0gS6wHbI89Yy-jlDZISGEBbK07HmdqyNip7ZHIW_SR6zQp3bG6VzrfOVe6B6GvlFxTQtqbRBlhsiJUVYRIJavtJ3RKhWgqohp6tNs5rRpV1yfoLKUXQlirWvEZndSM1LwR7Sn6PQ_jBqJLweOwwo8RphGyM_jO5wgmgnewxgs7hhh_wmDx7dsGfHIFB9_j5ZRNGG3CszH4AT8Uq_U54SJ_c9GajJex-Ge-RAYYpjXs1Gcb01SGyzA6j193OgzBu5TTBTpewTrZL4d5jp6-3z7OF9X98sfdfHZfGc5prhRvBfCGN5J2gnFDaiCKyh56qRQAdKInDAwVTDVM9EaaTjIpCip6blhXn6Orfe4mhl-TTVm_hCn6clIzRcvPyrPaQrE9ZWJIKdqV3kQ3QtxqSvSuBL0vQZcS9N8S9LaYLg_RUzfa_t3y7-sFqPdAKpIfbPx_-4PYPyE7lN8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2919330277</pqid></control><display><type>article</type><title>Comparison of Traumatic Intracranial Hemorrhage Expansion and Outcomes Among Patients on Direct Oral Anticoagulants Versus Vitamin k Antagonists</title><source>MEDLINE</source><source>ProQuest Central (Alumni Edition)</source><source>SpringerLink Journals</source><source>ProQuest Central UK/Ireland</source><source>ProQuest Central</source><creator>Shin, Samuel S. ; Marsh, Elisabeth B. ; Ali, Hasan ; Nyquist, Paul A. ; Hanley, Daniel F. ; Ziai, Wendy C.</creator><creatorcontrib>Shin, Samuel S. ; Marsh, Elisabeth B. ; Ali, Hasan ; Nyquist, Paul A. ; Hanley, Daniel F. ; Ziai, Wendy C.</creatorcontrib><description>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.</description><identifier>ISSN: 1541-6933</identifier><identifier>EISSN: 1556-0961</identifier><identifier>DOI: 10.1007/s12028-019-00898-y</identifier><identifier>PMID: 32034657</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Accidental Falls ; Aged ; Aged, 80 and over ; Anticoagulants ; Anticoagulants - adverse effects ; Antifibrinolytic Agents - therapeutic use ; Antithrombins - adverse effects ; Blood Coagulation Factors - therapeutic use ; Cardiac arrhythmia ; Cardiovascular disease ; Coagulants - therapeutic use ; Coronary vessels ; Critical Care Medicine ; Dabigatran - adverse effects ; Disease Progression ; Electronic health records ; Emergency medical care ; Factor Xa Inhibitors - adverse effects ; Female ; Glasgow Outcome Scale ; Heart failure ; Hematoma ; Hemorrhage ; Hospitals ; Humans ; Hyperlipidemia ; Hypertension ; Intensive ; Internal Medicine ; Intracranial Hemorrhage, Traumatic - chemically induced ; Intracranial Hemorrhage, Traumatic - physiopathology ; Intracranial Hemorrhage, Traumatic - therapy ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Neurology ; Neurosurgical Procedures ; Original Work ; Patients ; Plasma ; Platelet Transfusion ; Pyrazoles - adverse effects ; Pyridines - adverse effects ; Pyridones - adverse effects ; Retrospective Studies ; Rivaroxaban - adverse effects ; Thiazoles - adverse effects ; Trauma ; Traumatic brain injury ; Vein & artery diseases ; Vitamin K - therapeutic use ; Warfarin - adverse effects</subject><ispartof>Neurocritical care, 2020-04, Vol.32 (2), p.407-418</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-9475a464681b524c03a0918dad899aaab5d02ac1529625dc8cb82855245d4c2b3</citedby><cites>FETCH-LOGICAL-c441t-9475a464681b524c03a0918dad899aaab5d02ac1529625dc8cb82855245d4c2b3</cites><orcidid>0000-0003-4548-7353</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12028-019-00898-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2919330277?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21388,21389,27924,27925,33530,33744,41488,42557,43659,43805,51319,64385,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32034657$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shin, Samuel S.</creatorcontrib><creatorcontrib>Marsh, Elisabeth B.</creatorcontrib><creatorcontrib>Ali, Hasan</creatorcontrib><creatorcontrib>Nyquist, Paul A.</creatorcontrib><creatorcontrib>Hanley, Daniel F.</creatorcontrib><creatorcontrib>Ziai, Wendy C.</creatorcontrib><title>Comparison of Traumatic Intracranial Hemorrhage Expansion and Outcomes Among Patients on Direct Oral Anticoagulants Versus Vitamin k Antagonists</title><title>Neurocritical care</title><addtitle>Neurocrit Care</addtitle><addtitle>Neurocrit Care</addtitle><description>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.</description><subject>Accidental Falls</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants</subject><subject>Anticoagulants - adverse effects</subject><subject>Antifibrinolytic Agents - therapeutic use</subject><subject>Antithrombins - adverse effects</subject><subject>Blood Coagulation Factors - therapeutic use</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Coagulants - therapeutic use</subject><subject>Coronary vessels</subject><subject>Critical Care Medicine</subject><subject>Dabigatran - adverse effects</subject><subject>Disease Progression</subject><subject>Electronic health records</subject><subject>Emergency medical care</subject><subject>Factor Xa Inhibitors - adverse effects</subject><subject>Female</subject><subject>Glasgow Outcome Scale</subject><subject>Heart failure</subject><subject>Hematoma</subject><subject>Hemorrhage</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hyperlipidemia</subject><subject>Hypertension</subject><subject>Intensive</subject><subject>Internal Medicine</subject><subject>Intracranial Hemorrhage, Traumatic - chemically induced</subject><subject>Intracranial Hemorrhage, Traumatic - physiopathology</subject><subject>Intracranial Hemorrhage, Traumatic - therapy</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neurology</subject><subject>Neurosurgical Procedures</subject><subject>Original Work</subject><subject>Patients</subject><subject>Plasma</subject><subject>Platelet Transfusion</subject><subject>Pyrazoles - adverse effects</subject><subject>Pyridines - adverse effects</subject><subject>Pyridones - adverse effects</subject><subject>Retrospective Studies</subject><subject>Rivaroxaban - adverse effects</subject><subject>Thiazoles - adverse effects</subject><subject>Trauma</subject><subject>Traumatic brain injury</subject><subject>Vein & artery diseases</subject><subject>Vitamin K - therapeutic use</subject><subject>Warfarin - adverse effects</subject><issn>1541-6933</issn><issn>1556-0961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc1OGzEUha0KVP76Al0gS6wHbI89Yy-jlDZISGEBbK07HmdqyNip7ZHIW_SR6zQp3bG6VzrfOVe6B6GvlFxTQtqbRBlhsiJUVYRIJavtJ3RKhWgqohp6tNs5rRpV1yfoLKUXQlirWvEZndSM1LwR7Sn6PQ_jBqJLweOwwo8RphGyM_jO5wgmgnewxgs7hhh_wmDx7dsGfHIFB9_j5ZRNGG3CszH4AT8Uq_U54SJ_c9GajJex-Ge-RAYYpjXs1Gcb01SGyzA6j193OgzBu5TTBTpewTrZL4d5jp6-3z7OF9X98sfdfHZfGc5prhRvBfCGN5J2gnFDaiCKyh56qRQAdKInDAwVTDVM9EaaTjIpCip6blhXn6Orfe4mhl-TTVm_hCn6clIzRcvPyrPaQrE9ZWJIKdqV3kQ3QtxqSvSuBL0vQZcS9N8S9LaYLg_RUzfa_t3y7-sFqPdAKpIfbPx_-4PYPyE7lN8</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Shin, Samuel S.</creator><creator>Marsh, Elisabeth B.</creator><creator>Ali, Hasan</creator><creator>Nyquist, Paul A.</creator><creator>Hanley, Daniel F.</creator><creator>Ziai, Wendy C.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><orcidid>https://orcid.org/0000-0003-4548-7353</orcidid></search><sort><creationdate>20200401</creationdate><title>Comparison of Traumatic Intracranial Hemorrhage Expansion and Outcomes Among Patients on Direct Oral Anticoagulants Versus Vitamin k Antagonists</title><author>Shin, Samuel S. ; Marsh, Elisabeth B. ; Ali, Hasan ; Nyquist, Paul A. ; Hanley, Daniel F. ; Ziai, Wendy C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-9475a464681b524c03a0918dad899aaab5d02ac1529625dc8cb82855245d4c2b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Accidental Falls</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants</topic><topic>Anticoagulants - adverse effects</topic><topic>Antifibrinolytic Agents - therapeutic use</topic><topic>Antithrombins - adverse effects</topic><topic>Blood Coagulation Factors - therapeutic use</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Coagulants - therapeutic use</topic><topic>Coronary vessels</topic><topic>Critical Care Medicine</topic><topic>Dabigatran - adverse effects</topic><topic>Disease Progression</topic><topic>Electronic health records</topic><topic>Emergency medical care</topic><topic>Factor Xa Inhibitors - adverse effects</topic><topic>Female</topic><topic>Glasgow Outcome Scale</topic><topic>Heart failure</topic><topic>Hematoma</topic><topic>Hemorrhage</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hyperlipidemia</topic><topic>Hypertension</topic><topic>Intensive</topic><topic>Internal Medicine</topic><topic>Intracranial Hemorrhage, Traumatic - chemically induced</topic><topic>Intracranial Hemorrhage, Traumatic - physiopathology</topic><topic>Intracranial Hemorrhage, Traumatic - therapy</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neurology</topic><topic>Neurosurgical Procedures</topic><topic>Original Work</topic><topic>Patients</topic><topic>Plasma</topic><topic>Platelet Transfusion</topic><topic>Pyrazoles - adverse effects</topic><topic>Pyridines - adverse effects</topic><topic>Pyridones - adverse effects</topic><topic>Retrospective Studies</topic><topic>Rivaroxaban - adverse effects</topic><topic>Thiazoles - adverse effects</topic><topic>Trauma</topic><topic>Traumatic brain injury</topic><topic>Vein & artery diseases</topic><topic>Vitamin K - therapeutic use</topic><topic>Warfarin - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shin, Samuel S.</creatorcontrib><creatorcontrib>Marsh, Elisabeth B.</creatorcontrib><creatorcontrib>Ali, Hasan</creatorcontrib><creatorcontrib>Nyquist, Paul A.</creatorcontrib><creatorcontrib>Hanley, Daniel F.</creatorcontrib><creatorcontrib>Ziai, Wendy C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>Neurocritical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shin, Samuel S.</au><au>Marsh, Elisabeth B.</au><au>Ali, Hasan</au><au>Nyquist, Paul A.</au><au>Hanley, Daniel F.</au><au>Ziai, Wendy C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Traumatic Intracranial Hemorrhage Expansion and Outcomes Among Patients on Direct Oral Anticoagulants Versus Vitamin k Antagonists</atitle><jtitle>Neurocritical care</jtitle><stitle>Neurocrit Care</stitle><addtitle>Neurocrit Care</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>32</volume><issue>2</issue><spage>407</spage><epage>418</epage><pages>407-418</pages><issn>1541-6933</issn><eissn>1556-0961</eissn><abstract>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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32034657</pmid><doi>10.1007/s12028-019-00898-y</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-4548-7353</orcidid></addata></record> |
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| ispartof | Neurocritical care, 2020-04, Vol.32 (2), p.407-418 |
| issn | 1541-6933 1556-0961 |
| language | eng |
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| source | MEDLINE; ProQuest Central (Alumni Edition); SpringerLink Journals; ProQuest Central UK/Ireland; ProQuest Central |
| subjects | Accidental Falls Aged Aged, 80 and over Anticoagulants Anticoagulants - adverse effects Antifibrinolytic Agents - therapeutic use Antithrombins - adverse effects Blood Coagulation Factors - therapeutic use Cardiac arrhythmia Cardiovascular disease Coagulants - therapeutic use Coronary vessels Critical Care Medicine Dabigatran - adverse effects Disease Progression Electronic health records Emergency medical care Factor Xa Inhibitors - adverse effects Female Glasgow Outcome Scale Heart failure Hematoma Hemorrhage Hospitals Humans Hyperlipidemia Hypertension Intensive Internal Medicine Intracranial Hemorrhage, Traumatic - chemically induced Intracranial Hemorrhage, Traumatic - physiopathology Intracranial Hemorrhage, Traumatic - therapy Length of Stay Male Medicine Medicine & Public Health Middle Aged Mortality Neurology Neurosurgical Procedures Original Work Patients Plasma Platelet Transfusion Pyrazoles - adverse effects Pyridines - adverse effects Pyridones - adverse effects Retrospective Studies Rivaroxaban - adverse effects Thiazoles - adverse effects Trauma Traumatic brain injury Vein & artery diseases Vitamin K - therapeutic use Warfarin - adverse effects |
| title | Comparison of Traumatic Intracranial Hemorrhage Expansion and Outcomes Among Patients on Direct Oral Anticoagulants Versus Vitamin k Antagonists |
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