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Mild Traumatic Brain Injury in Elderly Patients Receiving Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis. | LitMetric

AI Article Synopsis

  • This study systematically reviewed and analyzed the risk and outcomes of traumatic intracerebral hemorrhage (tICH) in elderly patients with mild traumatic brain injury (mTBI) who were using direct oral anticoagulants (DOACs).
  • The findings showed that those using DOACs had a significantly lower risk of tICH compared to those on vitamin K antagonists (VKAs) and similar risks compared to those on antiplatelet therapy (APT).
  • Additionally, patients using DOACs experienced fewer instances of needing reversal agents and neurosurgical interventions compared to VKAs, while mortality rates and ICH progression were similar across all treatment groups.

Article Abstract

The aim of this work was to conduct a systematic review and meta-analysis of studies reporting on the risk of traumatic intracerebral hemorrhage (tICH), the course of tICH, and its treatment and mortality rates in elderly mild traumatic brain injury (mTBI) patients using direct oral anticoagulants (DOACs). We consulted PubMed and Embase for relevant cohort and case-control studies with a control group. Two authors independently selected studies, assessed methodological quality, and extracted outcome data. Estimates were pooled with the Mantel-Haenszel random-effects method. We identified 16 articles comprising 3671 elderly mTBI patients using DOACs. Use of DOACs was associated with a reduced risk of tICH compared to the use of vitamin K antagonists (VKAs; odds ratio [OR], 0.44; 95% confidence interval [CI], 0.29-0.65; I = 22%) and a similar risk compared to the use of antiplatelet therapy (APT; OR, 0.98; 95% CI, 0.39-2.44; I = 0%). Reversal agent use and neurosurgical intervention rate were lower in patients using DOACs compared to patients using VKAs (OR, 0.10; 95% CI, 0.06-0.16; I = 0% and OR, 0.37; 95% CI, 0.21-0.67; I = 0%, respectively). There was no significant difference in neurosurgical intervention rate between patients who used DOACs versus patients who used APT (OR, 0.58; 95% CI, 0.15-2.21; I = 41%) or no antithrombotic therapy (OR, 0.76; 95% CI, 0.20-2.86; I = 23%). ICH progression, risk of delayed ICH, and TBI-related in-hospital mortality were comparable among treatment groups. The present study indicates that elderly patients using DOACs have a lower risk of adverse outcome compared to patients using VKAs and a similar risk compared to patients using APT after mTBI.

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Source
http://dx.doi.org/10.1089/neu.2021.0435DOI Listing

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