PMID- 37853510
OWN - NLM
STAT- MEDLINE
DCOM- 20240304
LR  - 20240304
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 90
IP  - 4
DP  - 2024 Apr
TI  - Utility of Repeat Head Computed Tomography in Detecting Delayed Intracranial 
      Hemorrhage in Falls on Direct Oral Anticoagulants.
PG  - 691-694
LID - 10.1177/00031348231206582 [doi]
AB  - INTRODUCTION: Ground level falls in the elderly often lead to complications due 
      to use of anticoagulants (ACs). Intracranial hemorrhage (ICH), immediate or 
      delayed, is a feared consequence of such falls. The rate of delayed ICH (dICH) in 
      patients taking anticoagulants or antiplatelet (AP) agents ranges from .6% to 6%. 
      Patients on warfarin have a persistent rate of dICH, leading to implementation of 
      routine repeat head CTs at our institution. This policy was extended to direct 
      oral anticoagulants (DOACs). This study aims to determine institutional incidence 
      of DOAC-associated dICH. METHODS: With IRB waiver approval, we conducted a 
      retrospective review of trauma evaluations for falls on DOACs from 2016 to 2018. 
      We reviewed records for neurologic status, DOAC use, and results of initial and 
      delayed head CTs. Exclusion criteria included initial GCS </=14, new neurologic 
      deficits, traumatic findings on initial CT, concurrent use of additional AC/AP, 
      or absence of repeat head CT. RESULTS: Among 632 patients evaluated for falls on 
      AC/AP therapy, 159 (25%) of patients were included in the review. The age range 
      was 19-98 years old, with 99 females and 60 males. Half of the patients were on 
      apixaban, with the rest on dabigatran or rivaroxaban. Ten patients presented with 
      GCS of 14. No delayed hemorrhages were detected in this population. CONCLUSION: 
      The necessity of a repeat head CT in patients taking DOACs is debated in the 
      literature. Our analysis failed to demonstrate any delayed hemorrhage in 
      neurologically intact patients after head strike on DOAC, suggesting no 
      indication for follow-up imaging in this group.
FAU - Broderick, Meaghan
AU  - Broderick M
AUID- ORCID: 0000-0002-2135-601X
AD  - Department of Surgery, Stamford Hospital, Stamford, CT, USA. RINGGOLD: 332422
FAU - Tripodi, Gianluca
AU  - Tripodi G
AD  - Department of Surgery, Stamford Hospital, Stamford, CT, USA. RINGGOLD: 332422
FAU - Dwyer, Kevin
AU  - Dwyer K
AD  - Department of Surgery, Stamford Hospital, Stamford, CT, USA. RINGGOLD: 332422
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20231018
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Aged
MH  - Female
MH  - Male
MH  - Humans
MH  - Young Adult
MH  - Adult
MH  - Middle Aged
MH  - Aged, 80 and over
MH  - *Accidental Falls
MH  - *Intracranial Hemorrhages/chemically induced/diagnostic imaging
MH  - Tomography, X-Ray Computed
MH  - Anticoagulants/adverse effects
MH  - Fear
MH  - Platelet Aggregation Inhibitors
OTO - NOTNLM
OT  - DOAC
OT  - head trauma
OT  - intracranial hemorrhage
OT  - trauma
COIS- Declaration of Conflicting InterestsThe author(s) declared no potential conflicts 
      of interest with respect to the research, authorship, and/or publication of this 
      article.
EDAT- 2023/10/19 00:44
MHDA- 2024/03/04 06:48
CRDT- 2023/10/19 00:00
PHST- 2024/03/04 06:48 [medline]
PHST- 2023/10/19 00:44 [pubmed]
PHST- 2023/10/19 00:00 [entrez]
AID - 10.1177/00031348231206582 [doi]
PST - ppublish
SO  - Am Surg. 2024 Apr;90(4):691-694. doi: 10.1177/00031348231206582. Epub 2023 Oct 
      18.