Repeat computed tomography head scan is not indicated in trauma patients taking novel anticoagulation: A multicenter...

Area of Science:

• Trauma Surgery
• Neurosurgery
• Emergency Medicine
• Pharmacology

Background:

• Increasing use of novel oral anticoagulants (NOACs) in trauma patients.
• Uncertainty regarding risks and outcomes of delayed intracranial hemorrhage (ICH-d) in patients on NOACs.
• Variable practice patterns for repeat head CT scans (CTH) after initial negative CTH.

Purpose of the Study:

• To investigate the incidence and outcomes of ICH-d in trauma patients on NOACs compared to warfarin.
• To determine if ICH-d in NOAC patients leads to worse clinical outcomes.
• To evaluate the necessity of repeat CTH in this population.

Main Methods:

• Retrospective review of anticoagulated trauma patients from five level 1 trauma centers.
• Inclusion criteria: initial negative CTH.
• Primary outcomes: incidence of ICH-d, neurosurgical intervention, and death. Multivariable regression used to identify associated factors.

Main Results:

• 777 patients included (346 NOAC, 431 warfarin); 54% received repeat CTH.
• ICH-d incidence: 2.3% in NOAC group vs. 4% in warfarin group (p=0.31).
• No NOAC patient with ICH-d required neurosurgical intervention or died; warfarin patients had higher rates of intervention and death. Head AIS ≥3 was associated with increased ICH-d odds (aOR, 32.70; p<0.01).

Conclusions:

• The incidence of ICH-d in trauma patients on NOACs is low.
• ICH-d in NOAC patients did not necessitate neurosurgical intervention or result in death.
• Repeat CTH appears unnecessary for trauma patients on NOACs with an initially negative CTH.