In this episode, I’ll discuss whether the reversal of anticoagulants is necessary for neurologically intact patients with traumatic intracranial hemorrhage.
While intracranial hemorrhage (ICH) has the potential to lead to a catastrophic outcome in patients with traumatic injury who are also taking oral anticoagulants, the reversal of anticoagulation is not without risk of thrombotic complication. Therefore it could be possible that a subset of patients with a minor ICH exists where the risk:benefit might be in favor of not reversing anticoagulation.
To examine this possibility, a group of authors published a retrospective cohort study in Pharmacotherapy. The cohort looked at data from 35 trauma centers and analyzed 654 patients who were on preinjury anticoagulation and presented with a minor traumatic ICH without neurologic deficits. To be included patients needed to have a Glasgow Coma Scale score of 15 and other features that ensured the ICH was minor in nature. The primary outcome the authors examined was the rate of in-hospital mortality or transfer to hospice care.
In the overall cohort, 40% of the patients were reversed and 60% were not reversed. The rate of in-hospital mortality or hospice was 4.6% in those who were reversed compared with 4.9% in those who were not reversed. This difference was not statistically significant with a p value of 0.861. When the authors looked at a composite of in-hospital complications as a secondary outcome, the rates were 8% in those who were reversed compared with 8.7% in those who were not reversed. Again, this was not statistically significant with a p value of 0.748. Another secondary outcome, the average length of stay in the ICU, was numerically longer in the reversed group by 0.3 days but the p value for this outcome was 0.069, again not a significant difference.
In this retrospective study with carefully selected patient characteristics, the authors concluded:
This study found no difference in hospital outcomes between patients with minor traumatic ICH on oral anticoagulants who were neurologically intact that were reversed versus those who were not reversed. Further studies should continue to define the subset of traumatic ICH patients who may not require reversal of anticoagulation.
To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply