Clinical neurology and neurosurgery · 2026
Direct oral anticoagulant resumption patterns after traumatic subdural hemorrhage in atrial fibrillation: A multicenter cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Li Sean Y, Glauser Greg, Gonugunta Nikita, Kaelber David C, Ben-Israel David, Muram Sandeep, Bowles Alfred, Reddy Deven, Kelly Michael L
Аннотация
INTRODUCTION: Direct oral anticoagulant (DOAC) resumption guidelines after traumatic subdural hemorrhage (tSDH) remain unclear, given the competing risks of worsening hemorrhage and thromboembolic events. This study characterizes real-world DOAC prescription patterns after tSDH in patients with atrial fibrillation (AF) and evaluates outcomes comparing early and late prescription renewal.
METHODS: Using the TriNetX federated research database, we identified adult patients with incident tSDH, a preceding AF diagnosis, and a DOAC prescription within 3 months before injury (2014-2025). Renewal rates and all-cause mortality were tracked at 1, 2, 4, 8, and 12 weeks post-injury. Patients were stratified into early (≤4 weeks) and late (>4 weeks) renewal cohorts and compared following propensity score matching for 1-year rates of cerebral infarction, nontraumatic intracerebral hemorrhage (ICH), gastrointestinal (GI) bleeding, and all-cause mortality RESULTS: Among 4328 patients (mean age 78.2 years; 61% male), apixaban was the most prescribed pre-injury DOAC (76.7%). Renewal reached 17% at 1 week and 40% by 12 weeks; cumulative mortality was 18% by 12 weeks. After propensity score matching (750 patients per cohort), early renewal was not associated with significantly different rates of cerebral infarction, nontraumatic ICH, or GI bleeding. However, all-cause mortality was significantly higher in the early-renewal cohort (HR [95% CI]: 3.06 [2.33-4.01]) CONCLUSIONS: Early DOAC prescription renewal was associated with markedly higher all-cause mortality without a significant reduction in thromboembolic events. These findings may reflect residual confounding by AF severity, but underscore the need for prospective, injury-specific research to guide anticoagulation decision-making after tSDH.
METHODS: Using the TriNetX federated research database, we identified adult patients with incident tSDH, a preceding AF diagnosis, and a DOAC prescription within 3 months before injury (2014-2025). Renewal rates and all-cause mortality were tracked at 1, 2, 4, 8, and 12 weeks post-injury. Patients were stratified into early (≤4 weeks) and late (>4 weeks) renewal cohorts and compared following propensity score matching for 1-year rates of cerebral infarction, nontraumatic intracerebral hemorrhage (ICH), gastrointestinal (GI) bleeding, and all-cause mortality RESULTS: Among 4328 patients (mean age 78.2 years; 61% male), apixaban was the most prescribed pre-injury DOAC (76.7%). Renewal reached 17% at 1 week and 40% by 12 weeks; cumulative mortality was 18% by 12 weeks. After propensity score matching (750 patients per cohort), early renewal was not associated with significantly different rates of cerebral infarction, nontraumatic ICH, or GI bleeding. However, all-cause mortality was significantly higher in the early-renewal cohort (HR [95% CI]: 3.06 [2.33-4.01]) CONCLUSIONS: Early DOAC prescription renewal was associated with markedly higher all-cause mortality without a significant reduction in thromboembolic events. These findings may reflect residual confounding by AF severity, but underscore the need for prospective, injury-specific research to guide anticoagulation decision-making after tSDH.