Treatments used for patients after mild traumatic brain injury (MTBI) may need to include direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs), however the associated risk of intracranial haemorrhage (ICH) associated with DOACs remains unclear. To investigate this, researchers in Italy have compared the risk of early, delayed and comprehensive bleeding after MTBI, examining difference between the two treatment approaches. Included in the study were 451 patients: 268 receiving VKAs and 183 treated with DOACs. Overall intracranial bleeding was lower in DOAC-treated patients (7.7%) than in VKA-treated patients (14.9%, p = 0.026). The same trend was noted with early bleeding, which was lower in DOAC-treated patients (5.5%) than VKA-treated patients (11.6%, p = 0.030). Variables found to be significantly associated with higher ICH risk were identified as:

  • VKA therapy (odds ratio [OR] 2.327)
  • High-energy impact (OR 11.229)
  • Amnesia (OR 2.814)
  • Loss of consciousness (OR 5.286)
  • Glasgow Coma Scale score < 15 (OR 4.719)
  • Lesions present above the clavicles (OR 2.742)

The study, which can be viewed here, concludes that the risk of post-traumatic ICH was lower in patients treated with DOACs than in those treated with VKAs.

Contributed by Australian Medication Safety Services Associate – Isabella Singh