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Am J Emerg Med. 2018 Dec 4. pii: S0735-6757(18)30965-3. doi: 10.1016/j.ajem.2018.12.003. [Epub ahead of print]

Hemorrhagic risk and intracranial complications in patients with minor head injury (MHI) taking different oral anticoagulants.

Author information

1
Medicina e Chirurgia d'Accettazione e d'Urgenza, Pronto Soccorso, Ospedale San Paolo, ASL N°2 Savonese, Savona, Italy.
2
Medicina e Chirurgia d'Accettazione e d'Urgenza, Pronto Soccorso, Ospedale San Paolo, ASL N°2 Savonese, Savona, Italy. Electronic address: a.riccardi@asl2.liguria.it.

Abstract

The correlation between direct oral anticoagulants (DOACs) or Vitamin K Antagonist (VKAs) intake and the incidence of intracranial complications after minor head injury (MHI) is still object of debate: preliminary observation seems to demonstrate lower incidence in intracranial bleeding complications (ICH) in patients taking DOACs than VKA. METHODS. This prospective and observational study was performed to clarify the incidence of ICH in patients in DOACs compared to VKAs. Between January 2016 and April 2018 we have recorded in our ED patients with MHI taking oral anticoagulants. Their hemorragic risk score was calculated and recorded for each patient (Has Bled, Atria and Orbit). RESULTS A total of 402 patients with MHI taking anticoagulant were collected: 226 were receiving one of the four DOACs (dabigatran, rivaroxaban, apixaban or edoxaban) while 176 patients were in therapy with VKA. The rate of intracranial complications was significantly lower in patients receiving DOACs than in patients treated with VKA (p < 0.01). In the VKA group two patients died because of intracranial bleeding. No deaths were recorded in the DOACs group. DISCUSSION patients with MHI who take DOACs have a significant lower incidence of intracranial bleeding complications than those treated with vitamin k antagonists. This statement is supported by the observation that the hemorrhagic risk, measured according to the chosen scores, was similar between the two groups.

KEYWORDS:

Anticoagulants; DOACs; Minor head injury; NOACs

PMID:
30573225
DOI:
10.1016/j.ajem.2018.12.003

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