Anticoagulants and trauma - a winning combination
One might conclude the novel oral anticoagulants (NOACs), most of which are not reversible, would have worse outcomes in blunt trauma patients compared to warfarin, which is reversible, especially in those with head injuries. Surprisingly, the NOACs didn't increase the rate of ICH or risk of ICH progression nor did they increase risk of mortality compared with the other agents. Lowly aspirin, mostly at an 81mg dose, had the highest rate (and risk) of ICH compared to all other agents. The study was limited by a relatively small number of NOAC users, 7%; and patient enrollment at each center was voluntary, which could have led to sampling bias.
NOACs were not associated with an increased risk of traumatic ICH compared to other anticoagulant or antiplatelet agents.
Novel oral anticoagulants and trauma: The results of a prospective American Association for the Surgery of Trauma Multi-Institutional Trial. J Trauma Acute Care Surg. 2017 May;82(5):827-835. doi: 10.1097/TA.0000000000001414.
Peer Reviewed by Thomas Davis.