Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study.

IF 3 2区医学 Q1 EMERGENCY MEDICINE

Scandinavian Journal of Trauma Resuscitation & Emergency Medicine Pub Date : 2025-02-10 DOI:10.1186/s13049-025-01337-y

Nicolò Capsoni, Giovanni Carpani, Francesca Tarantino, Silvia Gheda, Jean Marc Cugnod, Sabrina Lanfranchi, Jhe Lee, Simone Lizza, Sara Marchesani, Enrica Meloni, Annalisa Rigamonti, Irene Serrai, Silvia Vergani, Elisa Ginevra Zuddio, Bruno Gherardo Zumbo, Daniele Privitera, Francesco Salinaro, Davide Bernasconi, Gianmarco Secco, Filippo Galbiati, Stefano Perlini, Michele Bombelli

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引用次数: 0

Abstract

Background: Anticoagulated patients with mild traumatic brain injury (mTBI) and a negative cerebral CT on admission, commonly undergo a repeated CT scan after observation in the emergency department (ED) to detect delayed intracranial hemorrhage (ICH). However, the utility of this practice is controversial, with recent evidence suggesting that the risk of delayed ICH in these patients is low. This study aims to evaluate incidence, outcomes, and risk factors of delayed ICH in patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) presenting to the ED with mTBI.

Methods: A multicenter, observational, retrospective cohort study was conducted in the EDs of three hospitals in Northern Italy, from January 2017 to December 2021. All consecutive adult patients on DOACs or VKAs therapy, admitted for a mTBI, who underwent a second CT scan after 12-24 h from a negative first one, were enrolled.

Results: A total of 1596 anticoagulated patients were enrolled, 869 (54%) on DOACs and 727 (46%) on VKAs therapy. The median age was 84 [79-88] and 56% of patients were females. The incidence of delayed ICH was 1.8% (95% CI: 1.1-3.0%; 14/869 patients) for DOACs, and 2.6% (95% CI: 1.6-4.1%; 19/727 patients) for VKAs patients, with no cases requiring neurosurgical intervention. Vomiting after head injury and the onset of new symptoms during observation were associated with a higher risk of delayed bleeding (OR 4.8; 95% CI: 1.4-16.5, and OR 4.7; 95% CI 1.2-23.7, respectively). At a 30-day follow-up, 2% of patients had a new ED admission related to their previous mTBI, with no significant difference between the groups.

Conclusions: Delayed ICH is uncommon among anticoagulated patients with mTBI and has minimal impact on their outcome. Routine performance of a second CT scan may be unnecessary and may be considered only in presence of high-risk clinical risk factors or signs of deterioration.

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抗凝患者轻度脑损伤后迟发性颅内出血的发生率及危险因素：一项多中心回顾性研究

背景：抗凝治疗的轻度外伤性脑损伤（mTBI）患者入院时CT阴性，通常在急诊科（ED）观察后反复进行CT扫描以检测迟发性颅内出血（ICH）。然而，这种做法的效用是有争议的，最近的证据表明，这些患者迟发性脑出血的风险很低。本研究旨在评估接受直接口服抗凝剂（DOACs）或维生素K拮抗剂（VKAs）治疗的mTBI患者迟发性脑出血的发生率、结局和危险因素。方法：2017年1月至2021年12月在意大利北部三家医院的急诊科进行了一项多中心、观察性、回顾性队列研究。所有连续接受DOACs或VKAs治疗的mTBI患者，在第一次阴性12-24小时后接受第二次CT扫描。结果：共纳入1596例抗凝患者，869例（54%）采用DOACs治疗，727例（46%）采用VKAs治疗。中位年龄84岁[79-88]，56%的患者为女性。迟发性脑出血发生率为1.8% (95% CI: 1.1-3.0%；14/869例患者)和2.6% (95% CI: 1.6-4.1%；19/727例)为vka患者，没有病例需要神经外科干预。颅脑损伤后呕吐和观察期间出现新症状与迟发性出血的高风险相关(OR 4.8；95% CI: 1.4-16.5， OR为4.7；95% CI分别为1.2-23.7)。在30天的随访中，2%的患者有与先前mTBI相关的新ED入院，两组之间无显著差异。结论：迟发性脑出血在mTBI抗凝患者中并不常见，对预后影响最小。常规的第二次CT扫描可能是不必要的，只有在存在高风险的临床危险因素或恶化的迹象时才可以考虑。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Scandinavian Journal of Trauma Resuscitation & Emergency Medicine EMERGENCY MEDICINE-

CiteScore

6.10

自引率

6.10%

发文量

审稿时长

6-12 weeks

期刊介绍： The primary topics of interest in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (SJTREM) are the pre-hospital and early in-hospital diagnostic and therapeutic aspects of emergency medicine, trauma, and resuscitation. Contributions focusing on dispatch, major incidents, etiology, pathophysiology, rehabilitation, epidemiology, prevention, education, training, implementation, work environment, as well as ethical and socio-economic aspects may also be assessed for publication.