Prevalence of Intracranial Hemorrhage after Blunt Head Trauma in Patients on Pre-injury Dabigatran

Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery.

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Incidence of Delayed Intracranial Hemorrhage in Older Patients After Blunt Head Trauma

JAMA Surgery ◽

10.1001/jamasurg.2017.6159 ◽

2018 ◽

Vol 153 (6) ◽

pp. 570 ◽

Cited By ~ 19

Author(s):

James A. Chenoweth ◽

Samuel D. Gaona ◽

Mark Faul ◽

James F. Holmes ◽

Daniel K. Nishijima ◽

...

Keyword(s):

Head Trauma ◽

Intracranial Hemorrhage ◽

Older Patients ◽

Blunt Head Trauma

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Antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000520 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000520

Author(s):

Scott M Alter ◽

Benjamin A Mazer ◽

Joshua J Solano ◽

Richard D Shih ◽

Mary J Hughes ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Head Trauma ◽

Intracranial Hemorrhage ◽

Injury Severity ◽

Head Injuries ◽

Antiplatelet Agents ◽

High Rate ◽

Head Ct ◽

Severity Scores ◽

Blunt Head Trauma

BackgroundAntiplatelet agents are increasingly used in cardiovascular treatment. Limited research has been performed into risks of acute and delayed traumatic intracranial hemorrhage (ICH) in these patients who sustain head injuries. Our goal was to assess the overall odds and identify factors associated with ICH in patients on antiplatelet therapy.MethodsA retrospective observational study was conducted at two level I trauma centers. Adult patients with head injuries on antiplatelet agents were enrolled from the hospitals’ trauma registries. Acute ICH was diagnosed by head CT. Observation and repeat CT to evaluate for delayed ICH was performed at clinicians’ discretion. Patients were stratified by antiplatelet type and analyzed by ICH outcome.ResultsOf 327 patients on antiplatelets who presented with blunt head trauma, 133 (40.7%) had acute ICH. Three (0.9%) had delayed ICH on repeat CT, were asymptomatic and did not require neurosurgical intervention. One with delayed ICH was on clopidogrel and two were on both clopidogrel and aspirin. Patients with delayed ICH compared with no ICH were older (94 vs 74 years) with higher injury severity scores (15.7 vs 4.4) and trended towards lower platelet counts (141 vs 216). Patients on aspirin had a higher acute ICH rate compared with patients on P2Y12 inhibitors (48% vs 30%, 18% difference, 95% CI 4 to 33; OR 2.18, 95% CI 1.15 to 4.13). No other group comparison had significant differences in ICH rate.ConclusionsPatients on antiplatelet agents with head trauma have a high rate of ICH. Routine head CT is recommended. Patients infrequently developed delayed ICH. Routine repeat CT imaging does not appear to be necessary for all patients.Level of evidenceLevel III, prognostic.

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Incidence of Delayed Intracranial Hemorrhage in Older Patients After Blunt Head Trauma

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2018.07.042 ◽

2018 ◽

Vol 55 (3) ◽

pp. 452

Author(s):

Sarah Markus

Keyword(s):

Head Trauma ◽

Intracranial Hemorrhage ◽

Older Patients ◽

Blunt Head Trauma

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Intracranial Hemorrhage after Blunt Head Trauma in Children with Bleeding Disorders

The Journal of Pediatrics ◽

10.1016/j.jpeds.2010.11.036 ◽

2011 ◽

Vol 158 (6) ◽

pp. 1003-1008.e2 ◽

Cited By ~ 11

Author(s):

Lois K. Lee ◽

Peter S. Dayan ◽

Michael J. Gerardi ◽

Dominic A. Borgialli ◽

Mohamed K. Badawy ◽

...

Keyword(s):

Head Trauma ◽

Intracranial Hemorrhage ◽

Bleeding Disorders ◽

Blunt Head Trauma

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Thromboembolic Prophylaxis in Blunt Traumatic Intracranial Hemorrhage: A Retrospective Review

The American Surgeon ◽

10.1177/000313480807401005 ◽

2008 ◽

Vol 74 (10) ◽

pp. 906-911 ◽

Cited By ~ 10

Author(s):

Aron J. Depew ◽

Charles K. Hu ◽

Andre C. Nguyen ◽

Natalie Driessen

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Head Trauma ◽

Intracranial Hemorrhage ◽

Intermittent Pneumatic Compression ◽

Thromboembolic Prophylaxis ◽

Vte Prophylaxis ◽

Vein Thrombosis ◽

Blunt Head Trauma ◽

Deep Vein

There are few data in the literature on venous thromboembolic (VTE) prophylaxis for the traumatic population with intracranial hemorrhage (ICH). We reviewed our institutional experience and compared the incidence of deep vein thrombosis and pulmonary embolism in patients with ICH receiving either early prophylaxis (<72 hours from admission) or late prophylaxis (>72 hours from admission), and the respective incidences in progression of intracranial hemorrhage. We identified 124 patients for this study. There were 29 patients (23%) who received early (<72 hours) pharmacological VTE prophylaxis and 53 patients (43%) received late (>72 hours) prophylaxis. In the study, 42 patients had intermittent pneumatic compression devices and received no pharmacological VTE prophylaxis. Among those with pharmacological VTE prophylaxis, 10 patients (8%) developed VTE (9 deep vein thrombosis and 1 pulmonary embolism). Three patients with pharmacological VTE prophylaxis developed ICH progression, with one being clinically significant. Our institutional review demonstrated that it seems safe to initiate early pharmacological VTE prophylaxis in blunt head trauma with stable ICH. Nevertheless, further prospective randomized studies are needed to fully elucidate the safety and efficacy in the timing of prophylaxis for blunt head trauma with ICH.

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