ArticleScandinavian journal of trauma, resuscitation and emergency medicine2018
The impact of direct oral anticoagulants in traumatic brain injury patients greater than 60-years-old.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it, 78 citations in OpenAlex.
- Systematic review on traumatic intracranial haemorrhage in patients on anti-thrombotic medications; haemorrhage progression, thrombosis, and anti-thrombotic recommencement.Neurosurgical review · 2023Pooled it
- Trial
- Preinjury Antithrombotic Use in Patients With Traumatic Brain Injury Varies by Level of Trauma Center.The Journal of surgical research · 2025Article
- Possible limited justification for systematic head computed tomography scans based solely on antithrombotic therapy in elderly patients (aged 75 or older) with mild traumatic brain injury.Research in diagnostic and interventional imaging · 2025Article
- Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Observational
- Effect of anticoagulation on isolated traumatic brain injury mortality using TQIP database: a propensity score analysis stratified by head injury severity.Trauma surgery & acute care open · 2025Article
- Article
- Effect of prior anticoagulation therapy on outcomes of traumatic brain injury: A systematic review and meta‑analysis.Experimental and therapeutic medicine · 2024Article
- [Update on point-of-care-based coagulation treatment : Systems, reagents, device-specific treatment algorithms].Die Anaesthesiologie · 2024Review
- Impact of antithrombotic therapy on acute and delayed intracranial haemorrhage and evaluation of the need of short-term hospitalisation based on CT findings after mild traumatic brain injury: experience from an oral and maxillofacial surgery unit.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Observational
- Predictors of direct oral anticoagulant concentrations in the trauma population.Trauma surgery & acute care open · 2024Article
- Justification of Indication for Cranial CT Imaging after Mild Traumatic Brain Injury According to the Current National Guidelines.Diagnostics (Basel, Switzerland) · 2023Article
- Clinical Indicators for Primary Cranial CT Imaging after Mild Traumatic Brain Injury-A Retrospective Analysis.Journal of clinical medicine · 2023Article
- Long-term outcomes after traumatic brain injury in elderly patients on antithrombotic therapy.Acta neurochirurgica · 2023Article
- Models of traumatic brain injury-highlights and drawbacks.Frontiers in neurology · 2023Review
- Cerebral infarction following administration of andexanet alfa for anticoagulant reversal in a patient with traumatic acute subdural hematoma.Surgical neurology international · 2023Article
- Management of Traumatic Brain Injury in Patients with DOAC Therapy-Are the "New" Oral Anticoagulants Really Safer?Journal of clinical medicine · 2022Article
- Treatment and outcomes of anticoagulated geriatric trauma patients with traumatic intracranial hemorrhage after falls.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- Are oral anticoagulants a risk factor for mild traumatic brain injury progression? A single-center experience focused on of direct oral anticoagulants and vitamin K antagonists.Acta neurochirurgica · 2022Article
- The significant impact of Coronavirus disease 2019 (COVID-19) on in-hospital mortality of elderly patients with moderate to severe traumatic brain injury: A retrospective observational study.Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2021Observational
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTraumatic 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.
methodsIn 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).
resultsOne-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).
conclusionIn 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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