To identify delayed hemorrhage, some clinicians will repeat a head CT in patients on NOAC’s with mild traumatic brian injury (TBI) after the initial head CT is negative.
How common
is delayed hemorrhage with DOAC’s?
Hmmm….
These
authors from Italy performed a retrospective multicentre observational study.
They found 1426 patients taking NOAC’s who were evaluated in the ED for
mild TBI (GCS 14-15). Of these 916 (68%) underwent 24 hours of observation and a
repeat CT after the initial one was negative.
In the end,
only 14 (1.5%) patients had delayed hemorrhage found on repeat CT. None of these
patients had neurosurgery or died (but I presume they had their DOAC’s withheld).
Another
interesting aspect… no delayed hemorrhages were found in patients who had the initial
head CT greater than 8 hours after injury.
The findings
of this study are similar with others looking at warfarin. Consistency in
the literature is comforting.
So, we have
a pretty simple message. Routine delayed head CT is not necessary. But
1.5% is not zero… so we still need to be a little careful.
And another
question… is it DOAC’s or NOAC’s?
Covering
Turcato G,
Cipriano A, Zaboli A, et al. Risk of delayed intracranial haemorrhage after
an initial negative CT in patients on DOACs with mild traumatic brain injury.
Am J Emerg Med. 2022;53:185-189. [link to article]
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