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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2018 | Original research

The impact of direct oral anticoagulants in traumatic brain injury patients greater than 60-years-old

Authors: Oliver Prexl, Martin Bruckbauer, Wolfgang Voelckel, Oliver Grottke, Martin Ponschab, Marc Maegele, Herbert Schöchl

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2018

Abstract

Background

Traumatic brain injury (TBI) is the leading cause of death among trauma patients. Patients under antithrombotic therapy (ATT) carry an increased risk for intracranial haematoma (ICH) formation. There is a paucity of data about the role of direct oral anticoagulants (DOACs) among TBI patients.

Methods

In this retrospective study, we investigated all TBI patients ≥60-years-old who were admitted to the intensive care unit (ICU) from January 2014 until May 2017. Patients were grouped into those receiving vitamin K antagonists (VKA), platelet inhibitors (PI), DOACs and no antithrombotic therapy (no-ATT).

Results

One-hundred-eighty-six, predominantly male (52.7%) TBI patients with a median age of 79 years (range: 70–85 years) were enrolled in the study. Glasgow Coma Scale and S-100β were not different among the groups. Patients on VKA and DOACs had a higher Charlson Comorbidity Index compared to the PI group and no-ATT group (p = 0.0021). The VKA group received reversal agents significantly more often than the other groups (p < 0.0001). Haematoma progression in the follow-up cranial computed tomography (CCT) was lowest in the DOAC group. The number of CCT and surgical interventions were low with no differences between the groups. No relevant differences in ICU and hospital length of stay were observed. Mortality in the VKA group was significantly higher compared to DOAC, PI and no-ATT group (p = 0.047).

Discussion

Data from huge registry studies displayed higher efficacy and lower fatal bleeding rates for DOACs compared to VKAs. The current study revealed comparable results. Despite the fact that TBI patients on VKAs received reversal agents more often than patients on DOACs (84.4% vs. 24.2%, p < 0.001), mortality rate was significantly higher in the VKA group (p = 0.047).

Conclusion

In patients ≥60 years suffering from TBI, anticoagulation with DOACs appears to be safer than with VKA. Anti-thrombotic therapy with VKA resulted in a worse outcome compared to DOACs and PI. Further studies are warranted to confirm this finding.

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Title: The impact of direct oral anticoagulants in traumatic brain injury patients greater than 60-years-old
Authors: Oliver Prexl
Martin Bruckbauer
Wolfgang Voelckel
Oliver Grottke
Martin Ponschab
Marc Maegele
Herbert Schöchl
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2018
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-018-0487-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The impact of direct oral anticoagulants in traumatic brain injury patients greater than 60-years-old

Abstract

Background

Methods

Results

Discussion

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Discussion

Conclusion

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