Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Dabigatran etexilate was the first direct-acting oral anticoagulant approved in the UnitedStates. The prevalence of intracranial hemorrhage after blunt head trauma in patients on dabigatranis currently unknown, complicating adequate ability to accurately compare the risks and benefitsof dabigatran to alternative anticoagulants. We aimed to determine the prevalence of intracranialhemorrhage for patients on dabigatran presenting to a Level I trauma center.

Methods: This is a retrospective observational study of adult patients on dabigatran who presented toa Level I trauma center and received cranial computed tomography (CT) following blunt head trauma.Patients who met inclusion criteria underwent manual chart abstraction. Our primary outcome wasintracranial hemorrhage on initial cranial CT.

Results: We included a total of 33 eligible patient visits for analysis. Mean age was 74.8 years (SD11.2, range 55-91). The most common cause of injury was ground-level fall (n = 22, 66.7%). One patient(3.0%, 95% confidence interval [CI] 0.[1-15.8%]) had intracranial hemorrhage on cranial CT. No patients(0%, 95% CI [0-8.7%]) required neurosurgical intervention. One in-hospital death occurred from infection.

Conclusion: To our knowledge, this is the first study to evaluate the prevalence of intracranialhemorrhage after blunt head trauma for patients on dabigatran presenting to the emergency department,including those not admitted. The intracranial hemorrhage prevalence in our study is similar to previousreports for patients on warfarin. Further studies are needed to determine if the prevalence of intracranialhemorrhage seen in our patient population is true for a larger patient population in more diverse clinicalsettings. [West J Emerg Med. 2017;18(5)794–799.]