Universität zu Köln

Prexl, Oliver, Bruckbauer, Martin, Voelckel, Wolfgang, Grottke, Oliver ORCID: 0000-0002-0722-3122, Ponschab, Martin, Maegele, Marc and Schoechl, Herbert (2018). The impact of direct oral anticoagulants in traumatic brain injury patients greater than 60-years-old. Scand. J. Trauma Resusc. Emerg. Med., 26. LONDON: BMC. ISSN 1757-7241

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Abstract

Background: Traumatic 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. Methods: In 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). Results: One-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-100 beta 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). Conclusion: In 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Prexl, Oliver UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruckbauer, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Voelckel, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Grottke, Oliver UNSPECIFIED orcid.org/0000-0002-0722-3122 UNSPECIFIED Ponschab, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Maegele, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Schoechl, Herbert UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-192429
DOI:	10.1186/s13049-018-0487-0
Journal or Publication Title:	Scand. J. Trauma Resusc. Emerg. Med.
Volume:	26
Date:	2018
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1757-7241
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROTHROMBIN COMPLEX CONCENTRATE; PREINJURY WARFARIN USE; INTRACRANIAL HEMORRHAGE; REVERSAL; DABIGATRAN; COMPLICATIONS; RIVAROXABAN; MANAGEMENT; MORTALITY; SURGERY Multiple languages Emergency Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19242