Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.
Department of Emergency Medicine, Haaglanden Medical Center, The Hague, the Netherlands; Dutch Institute for Clinical Auditing, Leiden, the Netherlands.
J Emerg Med. 2021 Mar;60(3):285-291. doi: 10.1016/j.jemermed.2020.09.012. Epub 2020 Oct 14.
Emergency departments (EDs) are faced with a growing number of patients with traumatic brain injury (TBI) using direct oral anticoagulants (DOACs). However, there remains uncertainty about the bleeding risk, rate of hematoma expansion, and the efficacy of reversal strategies in these patients.
This study aims to identify the risk of traumatic hemorrhagic complications in patients with TBI using DOACs.
In this retrospective study we included patients with TBI. All TBI patients were using DOACs, attended one of the three EDs of our hospital between January 2016 and October 2019, and received a computed tomography (CT) scan of the brain. The primary outcome was any traumatic intracranial hemorrhage on CT. Secondary outcomes were the use of reversal agents, secondary neurological deterioration, a neurosurgical intervention within 30 days after the injury, length of stay (LOS), Glasgow Outcome Scale (GOS) at discharge, and mortality.
Of the included patients (N = 316), 24 patients (7.6%, 95% confidence interval [CI] 4.2-9.8) presented with a traumatic intracranial hematoma (ICH). Seven patients (2.2%, 95% CI 0.6-3.8) received a reversal agent and 1 patient (0.3%, 95% CI -0.3-0.9) underwent a neurosurgical intervention. Of the 24 patients with a traumatic ICH, progression of the lesion was seen in 6 patients (1.9%, 95% CI 0.4-3.4). The mean LOS was 6.5 days (95% CI 3.0-10.1) and the mean GOS at discharge was 4 (95% CI 3.6-4.6). Death occurred in 1 patient (0.3%, 95% CI -0.3-0.9) suffering from an ICH.
Based on the present findings it can be postulated that TBI patients using DOACs have a low risk for ICH. Hematoma progression occurred, however, in a substantial number of patients. Considering the retrospective nature of the present study, future prospective trials are needed to confirm this finding.
急诊科面临越来越多使用直接口服抗凝剂（DOAC）的创伤性脑损伤（TBI）患者。然而，这些患者的出血风险、血肿扩大率以及逆转策略的疗效仍存在不确定性。
本研究旨在确定使用 DOAC 的 TBI 患者发生创伤性出血性并发症的风险。
在这项回顾性研究中，我们纳入了 TBI 患者。所有 TBI 患者均使用 DOAC，于 2016 年 1 月至 2019 年 10 月在我们医院的 3 个急诊科就诊之一，并接受了脑部计算机断层扫描（CT）。主要结局是 CT 上任何创伤性颅内出血。次要结局包括逆转剂的使用、继发性神经功能恶化、受伤后 30 天内的神经外科干预、住院时间（LOS）、出院时的格拉斯哥结局量表（GOS）评分和死亡率。
在纳入的患者中（N=316），24 名患者（7.6%，95%置信区间[CI]4.2-9.8）出现创伤性颅内血肿（ICH）。7 名患者（2.2%，95%CI0.6-3.8）接受了逆转剂治疗，1 名患者（0.3%，95%CI-0.3-0.9）接受了神经外科干预。在 24 名出现创伤性 ICH 的患者中，有 6 名患者（1.9%，95%CI0.4-3.4）出现了病变进展。平均 LOS 为 6.5 天（95%CI3.0-10.1），出院时平均 GOS 评分为 4 分（95%CI3.6-4.6）。1 名患者（0.3%，95%CI-0.3-0.9）死于 ICH。
根据目前的发现，可以推断使用 DOAC 的 TBI 患者发生 ICH 的风险较低。然而，大量患者出现了血肿进展。考虑到本研究的回顾性性质，需要进行未来的前瞻性试验来证实这一发现。
