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Traumatic Brain Injury and Anticoagulation

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Idarucizumab for Dabigatran Reversal - Full Cohort Analysis.
Pollack CV Jr, Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA, Dubiel R, Huisman MV, Hylek EM, Kam CW, Kamphuisen PW, Kreuzer J, Levy JH, Royle G, Sellke FW, Stangier J, Steiner T, Verhamme P, Wang B, Young L, Weitz JI.
N Engl J Med. 2017 Jul 11.

Rationale for inclusion: Multicenter, prospective study determined that idarucizumab rapidly reversed dabigatran anticoagulation in patients with uncontrolled bleeding or required reversal for an urgent procedure.

CAVEAT: This study was funded by Boehringer Ingelheim.

Citations - 0 (as of July 2017)

Novel oral anticoagulants and trauma: The results of a prospective American Association for the Surgery of Trauma Multi-Institutional Trial.
Kobayashi L, Barmparas G, Bosarge P, Brown CV, Bukur M, Carrick MM, Catalano RD, Holly-Nicolas J, Inaba K, Kaminski S, Klein AL, Kopelman T, Ley EJ, Martinez EM, Moore FO, Murry J, Nirula R, Paul D, Quick J, Rivera O, Schreiber M, Coimbra R; AAST Multicenter Prospective Observational Study of Trauma Patients on Novel Oral Anticoagulants Study Group.
J Trauma Acute Care Surg. 2017 May;82(5):827-835.

Rationale for inclusion: The effect of novel anticoagulants was examined in the prospective observational report from 16 trauma centers.  Patients on novel anticoagulants were not at higher risk for ICH, progression, or death.

Citations - 0 (as of July 2017)

The impact of preinjury antiplatelet and anticoagulant pharmacotherapy on outcomes in elderly patients with hemorrhagic brain injury.
Fortuna GR, Mueller EW, James LE, Shutter LA, Butler KL.
Surgery. 2008 Oct;144(4):598-603; discussion 603-5.

Rationale for inclusion: Age, ISS and GCS predicted mortality after TBI, but not preinjury use of clopidogrel, aspirin, or warfarin.

Citations - 85 (as of July 2017)

Degree of anticoagulation, but not warfarin use itself, predicts adverse outcomes after traumatic brain injury in elderly trauma patients.
Pieracci FM, Eachempati SR, Shou J, Hydo LJ, Barie PS.
J Trauma. 2007 Sep;63(3):525-30.

Rationale for inclusion: Patients with therapeutic levels of warfarin as measured by INR were more likely to have a depressed mental status, more likely to die, and more likely to die as a result of TBI than either those on non-therapeutic warfarin or no anticoagulation.

Citations - 117 (as of July 2017)

Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma.
Franko J, Kish KJ, O'Connell BG, Subramanian S, Yuschak JV.
J Trauma. 2006 Jul;61(1):107-10.

Rationale for inclusion: Large retrospective study indicating that increasing age and warfarin use were independently predictive of mortality after TBI.

Citations - 156 (as of July 2017)

Traumatic brain injury in anticoagulated patients.
Cohen DB, Rinker C, Wilberger JE.
J Trauma. 2006 Mar;60(3):553-7.

Rationale for inclusion: Prospective databases analyzed to find prohibitively high rates of progression of intracranial bleed (despite normal initial imaging), mental status deterioration, return to ED after discharge, need for craniotomy, and mortality in TBI patients on anticoagulation. 

Citations - 142 (as of July 2017)

Intracranial complications of preinjury anticoagulation in trauma patients with head injury.
Mina AA, Knipfer JF, Park DY, Bair HA, Howells GA, Bendick PJ.
J Trauma. 2002 Oct;53(4):668-72.

Rationale for inclusion:  Patients on preinjury anticoagulation were 4-5x as likely to die as a result of head injuries.

CAVEAT: Retrospective design introduces selection bias.

Citations - 169 (as of July 2017)

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