Direct oral anticoagulants may be a safe and effective treatment for older patients with traumatic brain injury

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Traumatic brain injury (TBI) is a primary cause of morbidity and mortality worldwide, and research suggests that elderly individuals may be at particularly high risk for poor outcomes after sustaining a head injury. Patients older than sixty years often require anticoagulants – drugs that prevent blood clots from forming in the veins, heart, and brain – as part of their treatment for TBI. A drug called VKA has been the most commonly prescribed anticoagulant for older TBI patients. However, VKA may put elderly patients at increased risk for fatal brain bleeding. As a result, researchers are investigating safer anticoagulants for elderly populations.

Researchers have identified direct oral anticoagulants (DOACs) as a potential alternative to VKA anticoagulants. DOACs generally work by interfering with the production of fibrin, a natural compound that allows blood clots to form. A recent Austrian study sought to examine the safety and effectiveness of DOACs as an alternative anticoagulant for elderly patients with TBI.

The study analyzed hospital data from 951 patients over sixty years of age who were admitted to the emergency department for TBI. They found that patients who received DOACs were less likely than those who received VKA to experience brain hematomas, or pooling of blood in the brain. Furthermore, those who received VKA treatment had a significantly higher mortality rate than the DOAC group.

Elderly patients with TBI are at high risk for negative injury-related outcomes, and they may require anticoagulant drugs as part of their treatment. Although VKA has been the most popular anticoagulant in recent decades, DOACs are a safer, more effective alternative.

Prexl O, Bruckbauer M, Voelckel W, et al. The impact of direct oral anticoagulants in traumatic brain injury patients greater than 60-years-old. Scandinavian Journal of Trauma, Resucitation, and Emergency Medicine. (March 2018).

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