Observational studyInternal and emergency medicine2021
Predictors of post-traumatic complication of mild brain injury in anticoagulated patients: DOACs are safer than VKAs.
Observational study in Internal and emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- Risk factors for traumatic intracranial hemorrhage in mild traumatic brain injury patients at the emergency department: a systematic review and meta-analysis.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Pooled it
- Incidence of intracranial bleeding in mild traumatic brain injury patients taking oral anticoagulants: a systematic review and meta-analysis.Journal of neurology · 2024Pooled it
- [Diagnostic algorithm for the management of patients ≥ 65 years with a mild traumatic brain injury in the emergency department].Unfallchirurgie (Heidelberg, Germany) · 2026Review
- Minimal head injury in asymptomatic patients on antithrombotic therapy: is in-hospital observation justified after an initial normal computed tomography scan?Internal and emergency medicine · 2026Article
- Regional differences in the management of patients with mild traumatic brain injury and antithrombotic therapy-an Austrian survey.Archives of orthopaedic and trauma surgery · 2026Article
- Traumatic brain injury in patients with mechanical heart valves on lifelong anticoagulation: incidence, management, and outcomes of intracranial hemorrhage.Frontiers in cardiovascular medicine · 2026Article
- The Use of Direct Oral Anticoagulants (DOACs) in the Geriatric Population-How to Overcome the Challenges of Geriatric Syndromes.Journal of clinical medicine · 2025Review
- 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
- Higher risk of traumatic intracranial hemorrhage with antiplatelet therapy compared to oral anticoagulation-a single-center experience.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
- Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department.Journal of clinical medicine · 2024Review
- In old anticoagulated patients with mild traumatic brain injury, a 24-h observation period should not be recommended without evidence of a clear benefit: a retrospective study of delayed hemorrhagic versus iatrogenic complications.Internal and emergency medicine · 2024Article
- Use of the Canadian CT head rule for patients on anticoagulant/anti-platelet therapy presenting with mild traumatic brain injury: prospective observational study.Frontiers in neurology · 2024Article
- Multi-centric study for development and validation of a CT head rule for mild traumatic brain injury in direct oral anticoagulants: the HERO-M nomogram.BMC emergency medicine · 2023Article
- Minimal is not minor also in patients with mild traumatic brain injury on oral direct anticoagulant therapy.Internal and emergency medicine · 2023Observational
- Cutaneous Impact Location Predicts Intracranial Injury Among the Elderly Population with Traumatic Brain Injury.Open access emergency medicine : OAEM · 2023Article
- Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- "Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy".BMC emergency medicine · 2022Article
- Acute haemorrhage rate in 28,000 Out-of-Hours CT heads.The British journal of radiology · 2022Article
- Predictors of post-traumatic complication of mild brain injury in anticoagulated patients: DOACs are safer than VKAs-comment.Internal and emergency medicine · 2021Article
Corrections and comments
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Authors and funding
12 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Although mild traumatic brain injury (MTBI) in people on oral anticoagulant treatment (OAT) is a frequent challenge for Emergency Department (ED), strong guidelines recommendations are lacking. In the attempt to assess the safety profile of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs), we have recruited 473 patients with a MTBI on OAT (43.6% males; age 81.8 ± 8.7 years), admitted to the Pisa's University Hospital ED (Jan 2016-Oct 2018). All patients underwent a head CT scan with those with no sign of acute bleedings remaining under clinical observation for the ensuing 24 h. Fifty patients (10.6%, 95% CI: 8.1-13.7%) had immediate intracranial hemorrhage (ICH), with a prevalence of patient-important outcomes due to immediate ICH of 1.1% (95% CI 0.4-2.4%); 3 patients died (0.6%, 95% CI 0.2-1.8) and 2 required neurosurgical intervention. Immediate ICHs were more frequent in VKA-treated than in DOAC-treated patients (15.9 vs. 6.4%. RR 2.5. 95%CI 1.4-4.4. p < 0.05). Multivariate analysis identified that post-traumatic amnesia, evidence of trauma above clavicles, high blood glucose, high blood pressure (BP) at arrival, and low prothrombin activity were predictors of immediate ICH. The prevalence of delayed ICH was 1.0% (95%CI 0.4-2.5%) without differences between DOACs and VKAs. Despite ICH being a frequent complication of MTBI in patients on OAT, immediate and delayed patient-important outcomes are rare. DOACs have a better safety profile than VKAs. Simple clinical parameters such as blood pressure at arrival or blood glucose might provide useful predictors of immediate ICH.Trial registration number: 11924_CIPRIANO. Local ethics committee approval number 33096.
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