Impact of Different DOACs on Complications of TBI After Low-Energy Trauma.

Background/

Objectives

While direct oral anticoagulants (DOACs) are widely used, robust evidence for low-energy trauma is scarce. Studies have shown similar or better outcomes of traumatic brain injury (TBI) under DOAC therapy compared to vitamin K antagonists, but there is limited data on the differences among DOAC types.

Methods

We performed a retrospective study of TBI patients with pre-injury DOACs who presented to our level 1 trauma unit and received cranial computed tomography. Only low-energy trauma mechanisms were included.

Results

We included 643 patients with an average age of 82 years. As per the Glasgow Coma Scale, 637 patients (99.1%) had a mild TBI and 34 patients (5.3%) had intracranial hematomas. No delayed intracranial bleeding occurred during in-hospital observation. Rivaroxaban was the most frequent DOAC (278, 43.2%), followed by apixaban (221, 34.4%), dabigatran (84, 13.1%), and edoxaban (60, 9.3%). Neurosurgical interventions were performed in three cases (0.5%). The head injury-related in-hospital mortality was 0.9% (six patients). Fisher's Exact Test and regression analysis did not demonstrate statistically significant differences among the DOAC types regarding occurrence of intracranial bleeding, surgical interventions, or mortality.

Conclusions

We found no statistically significant differences between DOACs regarding complications of TBI after low-energy trauma. This study shows an overall low risk of complications after low-energy trauma in a predominantly geriatric population with TBI and DOAC therapy.