scholarly journals Translational Insights into Traumatic Brain Injury Occurring during Dabigatran or Warfarin Anticoagulation

2014 ◽  
Vol 34 (5) ◽  
pp. 870-875 ◽  
Author(s):  
Jan Hendrik Schaefer ◽  
Wendy Leung ◽  
Limin Wu ◽  
Elizabeth M Van Cott ◽  
Josephine Lok ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracerebral Hemorrhage ◽  
Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Thrombin Time ◽  
Limited Data ◽  
Hemorrhage Volume ◽  
Post Hoc ◽  
Safety Advantage

To date, only limited data are available on the effects of pretreatment with novel oral anticoagulants in the event of traumatic brain injury (TBI). We determined intracerebral hemorrhage volume and functional outcome in a standardized TBI model in mice treated with warfarin or dabigatran. Additionally, we investigated whether excess concentrations of dabigatran could increase bleeding and whether this was preventable by using prothrombin complex concentrate (PCC). C57 mice were treated orally with warfarin or dabigatran; sham-treated mice served as controls. Effective anticoagulation was verified by measurement of international normalized ratio and diluted thrombin time, and TBI was induced by controlled cortical impact (CCI). Twenty-four hours after CCI, intracerebral hemorrhage volume was larger in warfarin-pretreated mice than in controls (10.1 ± 4.9 vs 4.1 ± 1.7 μL; analysis of variance post hoc P = 0.001), but no difference was found between controls and dabigatran-pretreated mice (5.3 ± 1.5 μL). PCC applied 30 minutes after CCI did not reliably reduce intracerebral hemorrhage induced by excess dabigatran concentration compared with saline (10.4 ± 11.2 vs 8.7 ± 7.1 μL). Our data suggest pathophysiological differences in TBI occurring during warfarin and dabigatran anticoagulation. The reduced hemorrhage formation under dabigatran therapy could present a safety advantage compared with warfarin. An excess dabigatran concentration, however, can increase hemorrhage.

Erythropoietin in patients with traumatic brain injury and extracranial injury—A post hoc analysis of the erythropoietin traumatic brain injury trial

2017 ◽  
Vol 83 (3) ◽  
pp. 449-456 ◽  
Author(s):  
Markus B. Skrifvars ◽  
Michael Bailey ◽  
Craig French ◽  
Jeffrey Presneill ◽  
Alistair Nichol ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Post Hoc Analysis ◽  
Post Hoc

scholarly journals A Post Hoc Analysis of Osmotherapy Use in the Erythropoietin in Traumatic Brain Injury Study—Associations With Acute Kidney Injury and Mortality

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Markus B. Skrifvars ◽  
Michael Bailey ◽  
Elizabeth Moore ◽  
Johan Mårtensson ◽  
Craig French ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Acute Kidney Injury ◽  
Brain Injury ◽  
Kidney Injury ◽  
Post Hoc Analysis ◽  
Post Hoc

scholarly journals The Effects of Repetitive Transcranial Magnetic Stimulation on Anxiety in Patients With Moderate to Severe Traumatic Brain Injury: A Post-hoc Analysis of a Randomized Clinical Trial

2020 ◽  
Vol 11 ◽  
Author(s):  
Priscila Aparecida Rodrigues ◽  
Ana Luiza Zaninotto ◽  
Hayden M. Ventresca ◽  
Iuri Santana Neville ◽  
Cintya Yukie Hayashi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Traumatic Brain Injury ◽  
Executive Function ◽  
Brain Injury ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Anxiety Symptoms ◽  
Severe Tbi ◽  
Post Hoc

Background: Traumatic brain injury (TBI) is one of the leading causes of neuropsychiatric disorders in young adults. Repetitive Transcranial Magnetic Stimulation (rTMS) has been shown to improve psychiatric symptoms in other neurologic disorders, such as focal epilepsy, Parkinson's disease, and fibromyalgia. However, the efficacy of rTMS as a treatment for anxiety in persons with TBI has never been investigated. This exploratory post-hoc analyzes the effects of rTMS on anxiety, depression and executive function in participants with moderate to severe chronic TBI.Methods: Thirty-six participants with moderate to severe TBI and anxiety symptoms were randomly assigned to an active or sham rTMS condition in a 1:1 ratio. A 10-session protocol was used with 10-Hz rTMS stimulation over the left dorsolateral prefrontal cortex (DLPFC) for 20 min each session, a total of 2,000 pulses were applied at each daily session (40 stimuli/train, 50 trains). Anxiety symptoms; depression and executive function were analyzed at baseline, after the last rTMS session, and 90 days post intervention.Results: Twenty-seven participants completed the entire protocol and were included in the post-hoc analysis. Statistical analysis showed no interaction of group and time (p > 0.05) on anxiety scores. Both groups improved depressive and executive functions over time, without time and group interaction (ps < 0.05). No adverse effects were reported in either intervention group.Conclusion: rTMS did not improve anxiety symptoms following high frequency rTMS in persons with moderate to severe TBI.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02167971.

1501: EFFECT OF TARGET-SPECIFIC ORAL ANTICOAGULANTS ON MORTALITY IN TRAUMATIC BRAIN INJURY

2016 ◽  
Vol 44 (12) ◽  
pp. 451-451
Author(s):  
Jason Hecht ◽  
Madelyn Batey ◽  
Cherise Callahan
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Oral Anticoagulants

scholarly journals What Is the Incidence of Intracranial Bleeding in Patients with Mild Traumatic Brain Injury? A Retrospective Study in 3088 Canadian CT Head Rule Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
C. E. Albers ◽  
M. von Allmen ◽  
D. S. Evangelopoulos ◽  
A. K. Zisakis ◽  
H. Zimmermann ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Platelet Aggregation Inhibitors ◽  
Intracranial Bleeding ◽  
Limited Data ◽  
Neurosurgical Treatment ◽  
Clinical Surveillance ◽  
Aggregation Inhibitors ◽  
Ct Head

Objective. Only limited data exists in terms of the incidence of intracranial bleeding (ICB) in patients with mild traumatic brain injury (MTBI).Methods. We retrospectively identified 3088 patients (mean age 41 range (7–99) years) presenting with isolated MTBI and GCS 14-15 at our Emergency Department who had undergone cranial CT (CCT) between 2002 and 2011. Indication for CCT was according to the “Canadian CT head rules.” Patients with ICB were either submitted for neurosurgical treatment or kept under surveillance for at least 24 hours. Pearson’s correlation coefficient was used to correlate the incidence of ICB with age, gender, or intake of coumarins, platelet aggregation inhibitors, or heparins.Results. 149 patients (4.8%) had ICB on CCT. No patient with ICB died or deteriorated neurologically. The incidence of ICB increased with age and intake of anticoagulants without clinically relevant correlation (R=0.11;P<0.001;R=-0.06;P<0.001).Conclusion. Our data show an incidence of 4.8% for ICB after MTBI. However, neurological deterioration after MTBI seems to be rare, and the need for neurosurgical intervention is only required in selected cases. The general need for CCT in patients after MTBI is therefore questionable, and clinical surveillance may be sufficient when CCT is not available.

scholarly journals The Comparison of Therapeutic Efficacy Between Dabigatran Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation

2021 ◽  
Vol 27 ◽  
pp. 107602962110447
Author(s):  
Hongxia Li ◽  
Lei Zhang ◽  
Ming Xia ◽  
Chi Zhang ◽  
Tingbo Jiang
Keyword(s):  
Atrial Fibrillation ◽  
Dabigatran Etexilate ◽  
Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Thrombin Time ◽  
Nonvalvular Atrial Fibrillation ◽  
Coagulation Assays ◽  
Warfarin Group ◽  
Dose Warfarin ◽  
Coagulation Status

Background Novel oral anticoagulants and warfarin are widely used for stroke prevention in patients with atrial fibrillation. The anticoagulation status of patients receiving warfarin or rivaroxaban has been studied. In this study, we aimed to evaluate the effect of dabigatran and warfarin on preventing thrombin generation (TG). Methods This retrospective study enrolled 237 nonvalvular atrial fibrillation (NVAF) subjects treated with 110 mg dabigatran etexilate twice daily and 224 NVAF patients received adjusted-dose warfarin (international normalized ratio [INR] of 2 to 3)). Coagulation assays, prothrombin fragment 1  +  2 (F1+2), calibrated automated thrombogram, and thrombin–antithrombin complex (TAT) were detected at the steady state. Results Activated partial thromboplastin time (APTT), antithrombin III activity, fibrinogen, and lag time showed no difference between the two groups. Compared to the dabigatran group, prothrombin time and INR values were higher in the warfarin group (all P < .001). Thrombin time, endogenous thrombin potential, peak TG (Cmax), F1+2, and TAT were lower in the warfarin group. The inhibition of TG was still stronger in the warfarin group when the patients were divided into subgroups. Conclusion Conventional coagulation assays are suboptimal for assessing the coagulation status of dabigatran. TG could be used as supplementary assays to evaluate the anticoagulation effect of oral anticoagulants. Our results suggest that warfarin may inhibit TG more aggressively than dabigatran in patients regardless of age and kidney function.

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