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- Title
Intake of NOAC is associated with hematoma expansion of intracerebral hematomas after traumatic brain injury.
- Authors
Markou, Markella; Pleger, Burkhard; Grözinger, Martin; Pintea, Bogdan; Hamsen, Uwe; Könen, Sabrina; Schildhauer, Thomas A.; Martínez, Ramón; Gousias, Konstantinos
- 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.
- Subjects
GERMANY; DISEASE progression; INTENSIVE care units; CARDIOPULMONARY resuscitation; HEMATOMA; CEREBRAL hemorrhage; ACADEMIC medical centers; ORAL drug administration; AGE distribution; ANTICOAGULANTS; RETROSPECTIVE studies; TREATMENT effectiveness; DESCRIPTIVE statistics; BRAIN injuries; LONGITUDINAL method; VITAMIN K; CHEMICAL inhibitors; DISEASE complications
- Publication
European Journal of Trauma & Emergency Surgery, 2021, Vol 47, Issue 2, p565
- ISSN
1863-9933
- Publication type
Article
- DOI
10.1007/s00068-019-01228-9