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?
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?
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]