Chenoweth James A, Johnson M Austin, Shook Laura, Sutter Mark E, Nishijima Daniel K, Holmes James F
University of California Davis, School of Medicine, Department of Emergency Medicine, Davis, California.
Veterans Affairs Northern California, Mather Medical Center, Mather, California.
West J Emerg Med. 2017 Aug;18(5):794-799. doi: 10.5811/westjem.2017.5.33092. Epub 2017 Jul 14.
Dabigatran etexilate was the first direct-acting oral anticoagulant approved in the United States. The prevalence of intracranial hemorrhage after blunt head trauma in patients on dabigatran is currently unknown, complicating adequate ability to accurately compare the risks and benefits of dabigatran to alternative anticoagulants. We aimed to determine the prevalence of intracranial hemorrhage for patients on dabigatran presenting to a Level I trauma center.
This is a retrospective observational study of adult patients on dabigatran who presented to a Level I trauma center and received cranial computed tomography (CT) following blunt head trauma. Patients who met inclusion criteria underwent manual chart abstraction. Our primary outcome was intracranial hemorrhage on initial cranial CT.
We included a total of 33 eligible patient visits for analysis. Mean age was 74.8 years (SD 11.2, range 55-91). The most common cause of injury was ground-level fall (n = 22, 66.7%). One patient (3.0%, 95% confidence interval [CI] 0.[1-15.8%]) had intracranial hemorrhage on cranial CT. No patients (0%, 95% CI [0-8.7%]) required neurosurgical intervention. One in-hospital death occurred from infection.
To our knowledge, this is the first study to evaluate the prevalence of intracranial hemorrhage after blunt head trauma for patients on dabigatran presenting to the emergency department, including those not admitted. The intracranial hemorrhage prevalence in our study is similar to previous reports for patients on warfarin. Further studies are needed to determine if the prevalence of intracranial hemorrhage seen in our patient population is true for a larger patient population in more diverse clinical settings.
达比加群酯是美国批准的首个直接作用口服抗凝剂。目前，服用达比加群的患者在钝性头部创伤后发生颅内出血的发生率尚不清楚，这使得难以准确比较达比加群与其他抗凝剂的风险和获益。我们旨在确定在一级创伤中心就诊的服用达比加群的患者颅内出血的发生率。
这是一项对在一级创伤中心就诊且钝性头部创伤后接受头颅计算机断层扫描（CT）的服用达比加群的成年患者的回顾性观察研究。符合纳入标准的患者进行手工病历摘要。我们的主要结局是初次头颅CT上的颅内出血。
我们共纳入33例符合条件的患者就诊进行分析。平均年龄为74.8岁（标准差11.2，范围55 - 91岁）。最常见的损伤原因是平地跌倒（n = 22，66.7%）。1例患者（3.0%，95%置信区间[CI] 0.[1 - 15.8%]）头颅CT显示颅内出血。无患者（0%，95% CI [0 - 8.7%]）需要神经外科干预。1例患者因感染在院内死亡。
据我们所知，这是第一项评估急诊科就诊的服用达比加群的患者（包括未住院患者）钝性头部创伤后颅内出血发生率的研究。我们研究中的颅内出血发生率与先前关于服用华法林患者的报道相似。需要进一步研究以确定我们患者群体中观察到的颅内出血发生率在更多样化临床环境中的更大患者群体中是否真实。
