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Open AccessArticle

Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists

1
Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
2
Department of Clinical-Surgical, PhD School in Experimental Medicine, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
3
Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
4
Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
5
Department of Neurological Surgery, University of Illinois at Chicago, Chicago, IL 60656, USA
6
Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
7
Department of Drug Science, University of Pavia, Italy, -Saint Camillus International University of Health Sciences-Rome-Italy, 27100 Pavia, Italy
*
Author to whom correspondence should be addressed.
Medicina 2020, 56(6), 308; https://doi.org/10.3390/medicina56060308
Received: 28 May 2020 / Revised: 17 June 2020 / Accepted: 19 June 2020 / Published: 23 June 2020
(This article belongs to the Special Issue Traumatic Brain Injury: Current Efforts in Research and Clinical Care)
Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery. View Full-Text
Keywords: mild head trauma; anticoagulated patients; emergency department; direct anticoagulant drugs; DOAC; NOAC; new anticoagulant drugs; vitamin K antagonist anticoagulants; VKAs; mild head injury; minor head trauma; minor head injury; intracranial hemorrhage; surgery; ED revisit rates; intrahospital mortality; computed tomography; risk management; hemorrhage; observation mild head trauma; anticoagulated patients; emergency department; direct anticoagulant drugs; DOAC; NOAC; new anticoagulant drugs; vitamin K antagonist anticoagulants; VKAs; mild head injury; minor head trauma; minor head injury; intracranial hemorrhage; surgery; ED revisit rates; intrahospital mortality; computed tomography; risk management; hemorrhage; observation
MDPI and ACS Style

Savioli, G.; Ceresa, I.F.; Luzzi, S.; Gragnaniello, C.; Giotta Lucifero, A.; Del Maestro, M.; Marasco, S.; Manzoni, F.; Ciceri, L.; Gelfi, E.; Ricevuti, G.; Bressan, M.A. Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists. Medicina 2020, 56, 308.

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