TY - JOUR PY - 2020// TI - Risk factors associated with intracranial bleeding and neurosurgery in patients with mild traumatic brain injury who are receiving direct oral anticoagulants JO - American journal of emergency medicine A1 - Turcato, Gianni A1 - Zaboli, Arian A1 - Zannoni, Massimo A1 - Ricci, Giorgio A1 - Zorzi, Elisabetta A1 - Ciccariello, Laura A1 - Tenci, Andrea A1 - Pfeifer, Norbert A1 - Maccagnani, Antonio A1 - Bonora, Antonio SP - ePub EP - ePub VL - ePub IS - ePub N2 - BACKGROUND: The established clinical risk factors for post-traumatic intracranial bleeding have not been evaluated in patients receiving DOACs yet.

AIM: Evaluating the association between clinic and patient characteristics and post-traumatic intracranial bleeding (ICH) in patients with mild traumatic brain injury (MTBI) and DOACs.

METHODS: This is a retrospective observational study conducted on three Emergency Departments. Multivariate analysis provided association in terms of OR with the risk of ICH. The performance of the multivariate model, described in a nomogram, has been tested with discrimination and decision curve analysis.

RESULTS: Of 473 DOACs patients with MTBI, 8.5% had post-traumatic ICH. On multivariable analysis, major dynamics (odds ratio [OR] 6.255), post-traumatic amnesia (OR 3.961), post-traumatic loss of consciousness (LOC, OR 7.353), Glasgow Coma Scale (GCS) score < 15 (OR 3.315), post-traumatic headache (OR 4.168) and visible trauma above the clavicles (OR 3.378) were associated with a higher likelihood of ICH. The multivariate model, used for the nomogram construction, showed a good performance (AUC bias corrected with 5000 bootstraps resample 0.78). The DCAs showed a net clinical benefit of the prognostic model.

CONCLUSIONS: Clinical risk factors can be used in DOACs patients to better define the risk of post-traumatic ICH.

Copyright © 2020 Elsevier Inc. All rights reserved.

Language: en

LA - en SN - 0735-6757 UR - http://dx.doi.org/10.1016/j.ajem.2020.02.046 ID - ref1 ER -