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European Journal of Trauma and Emergency Surgery

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01-04-2021 | Central Nervous System Trauma | Original Article

Intake of NOAC is associated with hematoma expansion of intracerebral hematomas after traumatic brain injury

Authors: Markella Markou, Burkhard Pleger, Martin Grözinger, Bogdan Pintea, Uwe Hamsen, Sabrina Könen, Thomas A. Schildhauer, Ramón Martínez, Konstantinos Gousias

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2021

Abstract

Purpose

Novel oral anticoagulants are increasingly replacing vitamin K antagonists in the prophylaxis of thromboembolism as they are associated with lower incidence of spontaneous intracerebral hematomas and they do not require drug level monitoring. However, management dilemmas are apparent in patients on novel oral anticoagulants who have developed intracerebral hematomas after traumatic brain injury, since clinical experience with their reversal strategies is limited.

Methods

We retrospectively studied 90 patients with traumatic intracerebral hematomas undergoing treatment at the surgical intensive care unit of the BG University Clinic Bergmannsheil in Bochum between 2015 and 2018. We analyzed potential prognostic factors for their radiological (expansion of intracerebral hematoma) and clinical (patients’ outcome) course, in particular the role of novel oral anticoagulants.

Results

71.1% of patients were male; mean age was 67.3 years. Hematoma’s expansion occurred in 35.9% of our patients, whereas 62.2% of our cohort showed a favorable outcome, defined as Glasgow Outcome Scale 4 and 5. Intake of novel oral anticoagulants was associated with a higher rate of hematoma’s expansion compared to patients on vitamin K antagonists (p = 0.05) or to patients with normal coagulation status (p = 0.002). A younger age (p < 0.001) was identified as the sole independent prognostic factor for a more favorable outcome, after excluding our cases, who underwent a cardiopulmonary resuscitation.

Conclusions

Our data showed a higher rate of hematoma’s expansion in patients with traumatic intracerebral hematomas on novel oral anticoagulants vs. vitamin K antagonists and recommend the consideration of prophylactic reversal of the novel oral anticoagulants at admission. Larger prospective trials are warranted to conclude whether the current specific reversal protocols are safe and effective.

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Title: Intake of NOAC is associated with hematoma expansion of intracerebral hematomas after traumatic brain injury
Authors: Markella Markou
Burkhard Pleger
Martin Grözinger
Bogdan Pintea
Uwe Hamsen
Sabrina Könen
Thomas A. Schildhauer
Ramón Martínez
Konstantinos Gousias
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keywords: Central Nervous System Trauma
Hematoma
Oral Anticoagulant
Intracerebral Hematoma
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-019-01228-9

At a glance: The STEP trials

Springer Medicine

Intake of NOAC is associated with hematoma expansion of intracerebral hematomas after traumatic brain injury

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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