Article
Is rivaroxaban associated with higher morbidity and mortality in patients with traumatic head injuries?
Search Medline for
Authors
-
Thorsten Jentzsch
- UniversitätsSpital Zürich, Zürich, Switzerland
-
Rudolf M. Moos
- UniversitätsSpital Zürich, Zürich, Switzerland
-
Valentin Neuhaus
- UniversitätsSpital Zürich, Zürich, Switzerland
-
Kariem Hussein
- Universität Zürich, Zürich, Switzerland
-
Jan Farei-Campagna
- UniversitätsSpital Zürich, Zürich, Switzerland
-
Burkhardt Seifert
- Universität Zürich, Zürich, Switzerland
-
Hans-Peter Simmen
- UniversitätsSpital Zürich, Zürich, Switzerland
-
Georg Osterhoff
- UniversitätsSpital Zürich, Zürich, Switzerland
| Published: | November 6, 2018 |
|---|
Outline
Text
Objectives: Traumatic brain injuries are common. The projected incidence varies by age and ranges between 13-23%. The associated mortality rate is approximately 3%. Rivaroxaban is a new anticoagulant that acts as a direct factor Xa inhibitor. It does not to be monitored with laboratory assessments and is wideley used for atrial fibrillation and postoperative thromboembolism prophylaxis. Recent studies suggested contrasting evidence whether rivaroxaban may increase intracranial re-hemorrhage and mortality in patients with traumatic brain injury. Therefore, the aim of this study was to examine whether the morbidity and mortality differs in traumatic head injury patients depending on the type of anticoagulant.
Methods: A retrospective cohort study was conducted in 2009-2014. Based on sex, age, and Glasgow-Coma Scale (GCS), patients that received rivaroxaban were matched to two control groups, one that received no anticoagulant and another one that received phenprocoumon. The primary outcome was mortality. Among others, secondary outcome variables were the length of stay (LOS) at the hospital and presence of an intracranial injury.
Results and conclusion: Sixty-nine patients and 23 patients per group were analyzed. The characteristics of patients did not differ significantly across groups. There were no significant differences between groups for the primary and secondary outcomes. Two patients died in the rivaroxaban group, while no patient died in the other two groups (p=0.32). The LOS at the hospital was similar (5.0, 4.0, and 5.0 days; p=0.94). An intracranial injury was observed in a similar number of patients in all groups (n=11, n=10, and n=8; p=0.75).
Although limited in size, this study did not observe significant outcome differences in patients with traumatic head injuries, who received rivaroxaban, no anticoagulant or phenprocoumon. Although not significant, the only two deaths in the study occurred in the rivaroxaban group. Larger studies are needed before clinical application of these findings.
