Galinos Barmparas1, Leslie Kobayashi2, Navpreet K Dhillon3, Kavita A Patel3, Eric J Ley3, Raul Coimbra2, Daniel R Margulies3. 1. Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Galinos.Barmparas@cshs.org. 2. Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, CA, USA. 3. Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Abstract
BACKGROUND: The aim of this study was to characterize the risk of a delayed intracranial hemorrhage (ICH) in trauma patients on direct-acting oral anticoagulants (DOACs). METHODS: Patients on DOACs admitted to two Level I Trauma Centers between 2014 and 2017 were reviewed. Only patients with a negative admission CT brain were included. The primary outcome was a delayed ICH. RESULTS: Overall, 249 patients were included. The median age was 81 years with 82% undergoing a repeat CT. Three patients developed a delayed ICH (1.2%). One developed an ICH after receiving tissue plasminogen activator for a cerebrovascular accident after two negative CTs. Excluding this patient, the incidence dropped to 0.8%. None required neurosurgical intervention. CONCLUSION: For patients at risk for a TBI who are on DOACs, repeat cross-sectional imaging of the brain when the initial imaging is negative is not necessary. A period of clinical observation may be warranted.
BACKGROUND: The aim of this study was to characterize the risk of a delayed intracranial hemorrhage (ICH) in traumapatients on direct-acting oral anticoagulants (DOACs). METHODS:Patients on DOACs admitted to two Level I Trauma Centers between 2014 and 2017 were reviewed. Only patients with a negative admission CT brain were included. The primary outcome was a delayed ICH. RESULTS: Overall, 249 patients were included. The median age was 81 years with 82% undergoing a repeat CT. Three patients developed a delayed ICH (1.2%). One developed an ICH after receiving tissue plasminogen activator for a cerebrovascular accident after two negative CTs. Excluding this patient, the incidence dropped to 0.8%. None required neurosurgical intervention. CONCLUSION: For patients at risk for a TBI who are on DOACs, repeat cross-sectional imaging of the brain when the initial imaging is negative is not necessary. A period of clinical observation may be warranted.
Authors: Thaddeus J Puzio; Patrick B Murphy; Heather R Kregel; Ryan C Ellis; Travis Holder; Michael W Wandling; Charles E Wade; Lillian S Kao; Michelle K McNutt; John A Harvin Journal: J Am Coll Surg Date: 2021-03-22 Impact factor: 6.113
Authors: Patrick G Hughes; Scott M Alter; Spencer W Greaves; Benjamin A Mazer; Joshua J Solano; Richard D Shih; Lisa M Clayton; Nhat Q Trinh; Lawrence Lottenberg; Mary J Hughes Journal: J Emerg Trauma Shock Date: 2021-09-30