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Risk factors associated with intracranial bleeding and neurosurgery in patients with mild traumatic brain injury who are receiving direct oral anticoagulants.

Authors :
Turcato, Gianni
Zaboli, Arian
Zannoni, Massimo
Ricci, Giorgio
Zorzi, Elisabetta
Ciccariello, Laura
Tenci, Andrea
Pfeifer, Norbert
Maccagnani, Antonio
Bonora, Antonio
Source :
American Journal of Emergency Medicine; May2021, Vol. 43, p180-185, 6p
Publication Year :
2021

Abstract

<bold>Background: </bold>The established clinical risk factors for post-traumatic intracranial bleeding have not been evaluated in patients receiving DOACs yet.<bold>Aim: </bold>Evaluating the association between clinic and patient characteristics and post-traumatic intracranial bleeding (ICH) in patients with mild traumatic brain injury (MTBI) and DOACs.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>Clinical risk factors can be used in DOACs patients to better define the risk of post-traumatic ICH. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
07356757
Volume :
43
Database :
Supplemental Index
Journal :
American Journal of Emergency Medicine
Publication Type :
Academic Journal
Accession number :
150066653
Full Text :
https://doi.org/10.1016/j.ajem.2020.02.046