Rivaroxaban and intracranial haemorrhage after mild traumatic brain injury: A dangerous combination?

Highlights • Novel anticoagulants such as rivaroxaban are increasingly prescribed. • We retrospectively analyze patients with mild TBI and intracranial haemorrhage. • Rivaroxaban treatment increased mortality and rate of re-haemorrhage. • Lack of specific antidotes may contribute to unfavourable out...

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Published inClinical neurology and neurosurgery Vol. 136; pp. 73 - 78
Main Authors Beynon, Christopher, Potzy, Anna, Sakowitz, Oliver W, Unterberg, Andreas W
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier B.V 01.09.2015
Elsevier Limited
Subjects
Adult
Aged
Aged, 80 and over
Anticoagulants
Anticoagulants, Factor Xa inhibitors, Haemostasis, Intracerebral haemorrhage
Brain Injuries - complications
Brain Injuries - surgery
Cardiovascular disease
Factor Xa Inhibitors - therapeutic use
Female
Head injury
Humans
Intracranial Hemorrhage, Traumatic - complications
Intracranial Hemorrhage, Traumatic - drug therapy
Intracranial Hemorrhages - drug therapy
Intracranial Hemorrhages - etiology
Male
Middle Aged
Mortality
Neurology
Neurosurgery
Platelet Aggregation Inhibitors - therapeutic use
Retrospective Studies
Rivaroxaban - therapeutic use
Traumatic brain injury
Treatment Outcome
Head injury
Anticoagulants, Factor Xa inhibitors, Haemostasis, Intracerebral haemorrhage
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Abstract Highlights • Novel anticoagulants such as rivaroxaban are increasingly prescribed. • We retrospectively analyze patients with mild TBI and intracranial haemorrhage. • Rivaroxaban treatment increased mortality and rate of re-haemorrhage. • Lack of specific antidotes may contribute to unfavourable outcome.
AbstractList OBJECTIVESDespite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to reverse anticoagulant effects may increase the risk profile of patients with bleeding complications. The purpose of this study was to analyze the effects of pre-injury treatment with rivaroxaban on patients with mild traumatic brain injury (TBI) and traumatic intracranial haemorrhage (tICH).METHODSA total of 70 patients with tICH after mild TBI were included in this retrospective analysis and were categorized into three groups: group A (no antithrombotics n=37), group B (antiplatelet medication n=22, VKA=5), and group C (rivaroxaban n=6). Medical charts were reviewed for baseline characteristics, laboratory values, intracranial haemorrhage, repeated computed tomography (CT) scans, re-haemorrhage, Glasgow Coma Scale (GCS) scores and in-hospital mortality.RESULTSNo significant differences were observed for baseline characteristics. The rate of re-haemorrhage was significantly higher in group C (50%) than in group A (11%) (p<0.05). Two patients died and both had been treated with rivaroxaban which resulted in a significantly higher mortality rate of 33% in group C compared with groups A (0%) and B (0%). No significant differences were observed for GCS at discharge and length of hospital stay between survivors of groups A-C.CONCLUSIONSDespite major limitations of retrospective design and small patient numbers, our results suggest that rivaroxaban may exacerbate intracranial haemorrhage in patients with mild TBI. Further studies are needed to characterize the risk profile of this drug in patients with tICH.
Objectives Despite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to reverse anticoagulant effects may increase the risk profile of patients with bleeding complications. The purpose of this study was to analyze the effects of pre-injury treatment with rivaroxaban on patients with mild traumatic brain injury (TBI) and traumatic intracranial haemorrhage (tICH). Methods A total of 70 patients with tICH after mild TBI were included in this retrospective analysis and were categorized into three groups: group A (no antithrombotics n=37), group B (antiplatelet medication n=22, VKA=5), and group C (rivaroxaban n=6). Medical charts were reviewed for baseline characteristics, laboratory values, intracranial haemorrhage, repeated computed tomography (CT) scans, re-haemorrhage, Glasgow Coma Scale (GCS) scores and in-hospital mortality. Results No significant differences were observed for baseline characteristics. The rate of re-haemorrhage was significantly higher in group C (50%) than in group A (11%) (p<0.05). Two patients died and both had been treated with rivaroxaban which resulted in a significantly higher mortality rate of 33% in group C compared with groups A (0%) and B (0%). No significant differences were observed for GCS at discharge and length of hospital stay between survivors of groups A-C. Conclusions Despite major limitations of retrospective design and small patient numbers, our results suggest that rivaroxaban may exacerbate intracranial haemorrhage in patients with mild TBI. Further studies are needed to characterize the risk profile of this drug in patients with tICH.
•Novel anticoagulants such as rivaroxaban are increasingly prescribed.•We retrospectively analyze patients with mild TBI and intracranial haemorrhage.•Rivaroxaban treatment increased mortality and rate of re-haemorrhage.•Lack of specific antidotes may contribute to unfavourable outcome. Despite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to reverse anticoagulant effects may increase the risk profile of patients with bleeding complications. The purpose of this study was to analyze the effects of pre-injury treatment with rivaroxaban on patients with mild traumatic brain injury (TBI) and traumatic intracranial haemorrhage (tICH). A total of 70 patients with tICH after mild TBI were included in this retrospective analysis and were categorized into three groups: group A (no antithrombotics n=37), group B (antiplatelet medication n=22, VKA=5), and group C (rivaroxaban n=6). Medical charts were reviewed for baseline characteristics, laboratory values, intracranial haemorrhage, repeated computed tomography (CT) scans, re-haemorrhage, Glasgow Coma Scale (GCS) scores and in-hospital mortality. No significant differences were observed for baseline characteristics. The rate of re-haemorrhage was significantly higher in group C (50%) than in group A (11%) (p<0.05). Two patients died and both had been treated with rivaroxaban which resulted in a significantly higher mortality rate of 33% in group C compared with groups A (0%) and B (0%). No significant differences were observed for GCS at discharge and length of hospital stay between survivors of groups A–C. Despite major limitations of retrospective design and small patient numbers, our results suggest that rivaroxaban may exacerbate intracranial haemorrhage in patients with mild TBI. Further studies are needed to characterize the risk profile of this drug in patients with tICH.
Despite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to reverse anticoagulant effects may increase the risk profile of patients with bleeding complications. The purpose of this study was to analyze the effects of pre-injury treatment with rivaroxaban on patients with mild traumatic brain injury (TBI) and traumatic intracranial haemorrhage (tICH). A total of 70 patients with tICH after mild TBI were included in this retrospective analysis and were categorized into three groups: group A (no antithrombotics n=37), group B (antiplatelet medication n=22, VKA=5), and group C (rivaroxaban n=6). Medical charts were reviewed for baseline characteristics, laboratory values, intracranial haemorrhage, repeated computed tomography (CT) scans, re-haemorrhage, Glasgow Coma Scale (GCS) scores and in-hospital mortality. No significant differences were observed for baseline characteristics. The rate of re-haemorrhage was significantly higher in group C (50%) than in group A (11%) (p<0.05). Two patients died and both had been treated with rivaroxaban which resulted in a significantly higher mortality rate of 33% in group C compared with groups A (0%) and B (0%). No significant differences were observed for GCS at discharge and length of hospital stay between survivors of groups A-C. Despite major limitations of retrospective design and small patient numbers, our results suggest that rivaroxaban may exacerbate intracranial haemorrhage in patients with mild TBI. Further studies are needed to characterize the risk profile of this drug in patients with tICH.
Highlights • Novel anticoagulants such as rivaroxaban are increasingly prescribed. • We retrospectively analyze patients with mild TBI and intracranial haemorrhage. • Rivaroxaban treatment increased mortality and rate of re-haemorrhage. • Lack of specific antidotes may contribute to unfavourable outcome.
Objectives Despite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to reverse anticoagulant effects may increase the risk profile of patients with bleeding complications. The purpose of this study was to analyze the effects of pre-injury treatment with rivaroxaban on patients with mild traumatic brain injury (TBI) and traumatic intracranial haemorrhage (tICH). Methods A total of 70 patients with tICH after mild TBI were included in this retrospective analysis and were categorized into three groups: group A (no antithromboticsn=37), group B (antiplatelet medicationn=22, VKA=5), and group C (rivaroxabann=6). Medical charts were reviewed for baseline characteristics, laboratory values, intracranial haemorrhage, repeated computed tomography (CT) scans, re-haemorrhage, Glasgow Coma Scale (GCS) scores and in-hospital mortality. Results No significant differences were observed for baseline characteristics. The rate of re-haemorrhage was significantly higher in group C (50%) than in group A (11%) (p<0.05). Two patients died and both had been treated with rivaroxaban which resulted in a significantly higher mortality rate of 33% in group C compared with groups A (0%) and B (0%). No significant differences were observed for GCS at discharge and length of hospital stay between survivors of groups A-C. Conclusions Despite major limitations of retrospective design and small patient numbers, our results suggest that rivaroxaban may exacerbate intracranial haemorrhage in patients with mild TBI. Further studies are needed to characterize the risk profile of this drug in patients with tICH.
Author Sakowitz, Oliver W
Potzy, Anna
Unterberg, Andreas W
Beynon, Christopher
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Keywords Head injury
Anticoagulants, Factor Xa inhibitors, Haemostasis, Intracerebral haemorrhage
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Snippet Highlights • Novel anticoagulants such as rivaroxaban are increasingly prescribed. • We retrospectively analyze patients with mild TBI and intracranial...
•Novel anticoagulants such as rivaroxaban are increasingly prescribed.•We retrospectively analyze patients with mild TBI and intracranial...
Despite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to reverse...
Objectives Despite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to...
OBJECTIVESDespite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to...
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StartPage 73
SubjectTerms Adult
Aged
Aged, 80 and over
Anticoagulants
Anticoagulants, Factor Xa inhibitors, Haemostasis, Intracerebral haemorrhage
Brain Injuries - complications
Brain Injuries - surgery
Cardiovascular disease
Factor Xa Inhibitors - therapeutic use
Female
Head injury
Humans
Intracranial Hemorrhage, Traumatic - complications
Intracranial Hemorrhage, Traumatic - drug therapy
Intracranial Hemorrhages - drug therapy
Intracranial Hemorrhages - etiology
Male
Middle Aged
Mortality
Neurology
Neurosurgery
Platelet Aggregation Inhibitors - therapeutic use
Retrospective Studies
Rivaroxaban - therapeutic use
Traumatic brain injury
Treatment Outcome
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Title Rivaroxaban and intracranial haemorrhage after mild traumatic brain injury: A dangerous combination?
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