BACKGROUND AND IMPORTANCE: Dabigatran is a direct thrombin inhibitor gaining popularity as a stroke prevention agent in patients with atrial fibrillation. In comparison with warfarin, dabigatran showed superiority in stroke prevention, but lower rates of major hemorrhage and intracerebral hemorrhage. Although warfarin has a well-established reversal strategy, there is far less experience reversing dabigatran. CLINICAL PRESENTATION: We present our experience with 3 patients who experienced an intracranial hemorrhage either spontaneously or after low-energy cranial trauma and review the available literature describing dabigatran use in patients with traumatic brain injury. CONCLUSION: Intracranial hemorrhage in patients taking anticoagulants and/or antiplatelets can have either a benign or malignant clinical course. At this time, there is little experience with dabigatran reversal; however, several strategies for rapid reversal have been proposed. All patients with intracranial hemorrhage taking dabigatran should be admitted for close neurological monitoring and serial imaging.
BACKGROUND AND IMPORTANCE: Dabigatran is a direct thrombin inhibitor gaining popularity as a stroke prevention agent in patients with atrial fibrillation. In comparison with warfarin, dabigatran showed superiority in stroke prevention, but lower rates of major hemorrhage and intracerebral hemorrhage. Although warfarin has a well-established reversal strategy, there is far less experience reversing dabigatran. CLINICAL PRESENTATION: We present our experience with 3 patients who experienced an intracranial hemorrhage either spontaneously or after low-energy cranial trauma and review the available literature describing dabigatran use in patients with traumatic brain injury. CONCLUSION:Intracranial hemorrhage in patients taking anticoagulants and/or antiplatelets can have either a benign or malignant clinical course. At this time, there is little experience with dabigatran reversal; however, several strategies for rapid reversal have been proposed. All patients with intracranial hemorrhage taking dabigatran should be admitted for close neurological monitoring and serial imaging.
Authors: Alvaro Alonso; Lindsay G S Bengtson; Richard F MacLehose; Pamela L Lutsey; Lin Y Chen; Kamakshi Lakshminarayan Journal: Stroke Date: 2014-07-03 Impact factor: 7.914
Authors: Jan Hendrik Schaefer; Wendy Leung; Limin Wu; Elizabeth M Van Cott; Josephine Lok; Michael Whalen; Klaus van Leyen; Arne Lauer; Joanne van Ryn; Eng H Lo; Christian Foerch Journal: J Cereb Blood Flow Metab Date: 2014-02-19 Impact factor: 6.200
Authors: James A Chenoweth; M Austin Johnson; Laura Shook; Mark E Sutter; Daniel K Nishijima; James F Holmes Journal: West J Emerg Med Date: 2017-07-14
Authors: Abid D Khan; Anna J Elseth; Jacqueline A Brosius; Eliza Moskowitz; Sean C Liebscher; Michael J Anstadt; Julie A Dunn; John H McVicker; Thomas Schroeppel; Richard P Gonzalez Journal: Trauma Surg Acute Care Open Date: 2020-05-28