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Intake of NOAC is associated with hematoma expansion of intracerebral hematomas after traumatic brain injury

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Novel oral anticoagulants are increasingly replacing vitamin K antagonists in the prophylaxis of thromboembolism as they are associated with lower incidence of spontaneous intracerebral hematomas and they do not require drug level monitoring. However, management dilemmas are apparent in patients on novel oral anticoagulants who have developed intracerebral hematomas after traumatic brain injury, since clinical experience with their reversal strategies is limited.

Methods

We retrospectively studied 90 patients with traumatic intracerebral hematomas undergoing treatment at the surgical intensive care unit of the BG University Clinic Bergmannsheil in Bochum between 2015 and 2018. We analyzed potential prognostic factors for their radiological (expansion of intracerebral hematoma) and clinical (patients’ outcome) course, in particular the role of novel oral anticoagulants.

Results

71.1% of patients were male; mean age was 67.3 years. Hematoma’s expansion occurred in 35.9% of our patients, whereas 62.2% of our cohort showed a favorable outcome, defined as Glasgow Outcome Scale 4 and 5. Intake of novel oral anticoagulants was associated with a higher rate of hematoma’s expansion compared to patients on vitamin K antagonists (p = 0.05) or to patients with normal coagulation status (p = 0.002). A younger age (p < 0.001) was identified as the sole independent prognostic factor for a more favorable outcome, after excluding our cases, who underwent a cardiopulmonary resuscitation.

Conclusions

Our data showed a higher rate of hematoma’s expansion in patients with traumatic intracerebral hematomas on novel oral anticoagulants vs. vitamin K antagonists and recommend the consideration of prophylactic reversal of the novel oral anticoagulants at admission. Larger prospective trials are warranted to conclude whether the current specific reversal protocols are safe and effective.

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Acknowledgements

The results in this paper form the doctoral thesis (University of Bonn) of MM.

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Authors and Affiliations

  1. Department of Neurology and Psychotraumatology, BG Hospital Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Germany

    Markella Markou

  2. Medical School, Rheinische Friedrich-Wilhelms University of Bonn, Sigmund Freud 25, 53127, Bonn, Germany

    Markella Markou & Konstantinos Gousias

  3. Department of Neurology, BG Bergmannsheil University Hospital Bochum, Bürkle de la Camp Platz 1, 44789, Bochum, Germany

    Burkhard Pleger

  4. Department of Radiology, BG Bergmannsheil University Hospital Bochum, Bürkle de la Camp Platz 1, 44789, Bochum, Germany

    Martin Grözinger

  5. Department of Neurosurgery and Neurotraumatology, BG Bergmannsheil University Hospital Bochum, Bürkle de la Camp Platz 1, 44789, Bochum, Germany

    Bogdan Pintea, Sabrina Könen, Ramón Martínez & Konstantinos Gousias

  6. Department of General Surgery and Trauma Surgery, BG Bergmannsheil University Hospital Bochum, Bürkle de la Camp Platz 1, 44789, Bochum, Germany

    Uwe Hamsen & Thomas A. Schildhauer

  7. Department of Neurosurgery, St Marien Academic Hospital Lünen, University of Münster, Altstadtstr. 23, 44534, Lünen, Germany

    Konstantinos Gousias

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  1. Markella Markou
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  2. Burkhard Pleger
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Correspondence to Konstantinos Gousias.

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Markou, M., Pleger, B., Grözinger, M. et al. Intake of NOAC is associated with hematoma expansion of intracerebral hematomas after traumatic brain injury. Eur J Trauma Emerg Surg 47, 565–571 (2021). https://doi.org/10.1007/s00068-019-01228-9

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  • DOI: https://doi.org/10.1007/s00068-019-01228-9

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