Artikel
Contribution of the new oral anticoagulants in haematoma’s expansion after traumatic vs. spontaneous intracerebral haematomas
Die Rollevonneuen oralen Antikoagulantien in derHämatomaufblühung vontraumatischen vs. spontanen intrazerebralen Blutungen
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Veröffentlicht: | 8. Mai 2019 |
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Objective: Novel oral anticoagulants (NOAC) are increasingly prescribed replacing vitamin K antagonists (VKA) in the prophylaxis of thromboembolism, as they are associated with lower incidence of spontaneous intracerebral hematomas (ICH) and they do not require drug level monitoring. However, management dilemmas are apparent in patients on NOAC who have developed an ICH, since clinical experience with their reversal strategies is limited.
Methods: We retrospectively studied 135 patients with traumatic (n=90) or spontaneous (n=45) ICH undergoing treatment at the surgical intensive care of our clinic between 2015–2018. We analyzed potential prognostic factors for their radiological (i.e volume or expansion of ICH) and clinical (patients’ outcome at 30 days, surgical decision making) course, in particular the role of NOAC.
Results: 65.1% of the patients were male; mean age was 67.8 years. Patients on NOAC developed smaller ICH compared to patients on VKA (12.5 ml vs. 31.7 ml, p=0.043). Intake of NOAC, however, was associated with a higher rate of traumatic ICH expansion (HE) compared to patients on VKA. (p=0.018). A younger age (p=0.002), a higher GCS (p=0.034) and the absence of dilated pupil (p=0.012) at admission were identified as independent prognostic factors for a better outcome (Glasgow Outcome Scale 4&5).
Conclusion: Our data showed a higher HE-rate in patients with traumatic ICH on NOAC vs. VKA and support the notion for a prophylactic reversal of the NOAC at admission, as performed in patients with VKA for decades. Larger prospective trials are warranted to conclude whether the current specific reversal protocols are safe and effective.