Impact of Factor Xa Inhibitor Reversal with Prothrombin Complex Concentrate in Patients with Traumatic Brain Injuries

Area of Science:

• Neuroscience
• Pharmacology
• Trauma Surgery

Background:

• Anticoagulant use increases risks of traumatic brain injury (TBI) complications, including intracranial hemorrhage (ICH) progression and mortality.
• Prothrombin complex concentrates (PCCs) are used off-label for factor Xa inhibitor-associated hemorrhages, but consensus on their use in TBI is lacking.

Purpose of the Study:

• To evaluate the impact of PCC reversal on hemorrhage progression and outcomes in patients with TBI who were on preinjury factor Xa inhibitors.

Main Methods:

• A single-center retrospective cohort study included 115 adult patients with acute TBI on apixaban or rivaroxaban.
• Patients were grouped by PCC administration for reversal; propensity score matching was used.
• Primary outcome was hemorrhage stability within 48 hours; secondary outcomes included mortality and thromboembolic events.

Main Results:

• In the matched cohort (84 patients), no significant difference in hemorrhage progression was observed between the PCC reversal group (15.0%) and the no reversal group (10.8%).
• PCC administration did not significantly affect in-hospital mortality (9.5% vs. 7.1%) or the incidence of deep vein thrombosis (DVT).
• Median change in ICH volume was minimal and not significantly different between groups.

Conclusions:

• PCC use in patients with factor Xa inhibitor-associated ICH from mild TBI did not significantly impact hemorrhage progression.
• PCC treatment in this context did not lead to an increase in thromboembolic events.
• Further research is needed to establish optimal indications and outcomes for PCC use in TBI patients.