Observational Study
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World J Clin Cases. Aug 16, 2014; 2(8): 362-366
Published online Aug 16, 2014. doi: 10.12998/wjcc.v2.i8.362
Dabigatran etixilate and traumatic brain injury: Evolving anticoagulants require evolving care plans
Sam Pakraftar, Daniela Atencio, John English, Alain Corcos, Eric M Altschuler, Kurt Stahlfeld
Sam Pakraftar, Daniela Atencio, John English, Kurt Stahlfeld, Department of Surgery, UPMC Mercy, Pittsburgh, PA 15219, United States
Alain Corcos, Department of Trauma and Acute Care Surgery, UPMC Mercy, Pittsburgh, PA 15219, United States
Eric M Altschuler, Department of Neurosurgery, UPMC Mercy, Pittsburgh, PA 15219, United States
Author contributions: Pakraftar S, Stahlfeld K and Corcos A developed study design; Pakraftar S collected and analyzed data; Pakraftar S, Atencio D, English J and Stahlfeld K wrote manuscript; Corcos A, Stahlfeld K and Altschuler EM were involved in editing manuscript; all authors approved the final version of the manuscript.
Correspondence to: Kurt Stahlfeld, MD, Department of Surgery, UPMC Mercy, 1400 Locust St., Suite 6512, Pittsburgh, PA 15219, United States. stahlfeldk@upmc.edu
Telephone: +1-412-2328097 Fax: +1-412-2328096
Received: November 26, 2013
Revised: June 25, 2014
Accepted: July 12, 2014
Published online: August 16, 2014
Abstract

AIM: To investigate the outcomes of trauma patients with traumatic brain injury (TBI) on Dabigatran Etexilate (DE).

METHODS: Following IRB approval, all patients taking DE who were admitted to our level 1 trauma service were enrolled in the study. Injury complexity, length of stay (LOS), intensive care length of stay, operative intervention, therapeutic interventions and outcomes were analyzed retrospectively.

RESULTS: Twenty-eight of 4310 admissions were taking DE. Eleven patients were excluded on concurrent antiplatelet therapy. Average age was 77.14 years (64-94 years), and average LOS was 4.7 d (1-35 d). Thirty-two percent were admitted with intracranial hemorrhage. Eighteen percent received factor VII, and 22% received dialysis in attempts to correct coagulopathy. Mortality was 21%.

CONCLUSION: The low incidence, absence of reversal agents, and lack of practice guidelines makes managing patients with TBI taking DE frustrating and provider specific. Local practice guidelines may be helpful in managing such patients.

Keywords: Dabigatran, Brain injury, Anticoagulation, Dabigatran reversal

Core tip: Dabigatran Etexilate (DE) and other novel anticoagulants that lack reversal agents complicate the care of trauma patients. Current practice guidelines should be available to aid in managing patients with traumatic brain injury on DE.