Outcomes in Geriatric Emergency Department Patients with Blunt Head Trauma on Preinjury Factor Xa Inhibitors

Direct oral anticoagulants may increase the risk of intracranial hemorrhage and mortality in patients with blunt head trauma. Previous studies are limited by small sample size or retrospective design.

The objective of this study was to evaluate the association of direct factor Xa inhibitors on intracranial hemorrhage and mortality in older adults with head trauma.

This is a secondary analysis of a large cohort study of geriatric emergency department (ED) patients with blunt head trauma. Patients ≥ 65 years presenting to the ED with blunt head trauma were included. Exclusion criteria included use of antiplatelet or anticoagulant medications other than apixaban and rivaroxaban. Intracranial hemorrhage was assessed via head computed tomography and outcomes. Patients were followed up for 30 days via telephone, medical records, and the state death registry. Odds ratios compared intracranial hemorrhage and mortality rates in patients on factor Xa inhibitors with those not anticoagulated.

Of 3031 eligible patients, 2294 were not on anticoagulant or antiplatelet agent, 505 were on apixaban, and 232 on rivaroxaban. Among those not on anticoagulation, 162 patients (7.1%) developed intracranial hemorrhage and 46 patients (6.2%) on factor Xa inhibitors experienced intracranial hemorrhage. Factor Xa inhibitors do not seem to increase the risk of intracranial hemorrhage (6.2% vs. 7.1%; p = 0.443) or 30-day mortality (7.9% vs. 6.8%; p = 0.345).

Factor Xa inhibitors were not found to be associated with an increased risk of intracranial hemorrhage in geriatric ED patients with blunt head trauma in our study. Additional studies need to be completed to confirm our findings.