title: Rivaroxaban and intracranial haemorrhage after mild traumatic brain injury: A dangerous combination?
abstract: OBJECTIVE
  Despite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to reverse anticoagulant effects may increase the risk profile of patients with bleeding complications. The purpose of this study was to analyze the effects of pre-injury treatment with rivaroxaban on patients with mild traumatic brain injury (TBI) and traumatic intracranial haemorrhage (tICH).
  
  
  METHODS
  A total of 70 patients with tICH after mild TBI were included in this retrospective analysis and were categorized into three groups: group A (no antithrombotics n=37), group B (antiplatelet medication n=22, VKA=5), and group C (rivaroxaban n=6). Medical charts were reviewed for baseline characteristics, laboratory values, intracranial haemorrhage, repeated computed tomography (CT) scans, re-haemorrhage, Glasgow Coma Scale (GCS) scores and in-hospital mortality.
  
  
  RESULTS
  No significant differences were observed for baseline characteristics. The rate of re-haemorrhage was significantly higher in group C (50%) than in group A (11%) (p<0.05). Two patients died and both had been treated with rivaroxaban which resulted in a significantly higher mortality rate of 33% in group C compared with groups A (0%) and B (0%). No significant differences were observed for GCS at discharge and length of hospital stay between survivors of groups A-C.
  
  
  CONCLUSIONS
  Despite major limitations of retrospective design and small patient numbers, our results suggest that rivaroxaban may exacerbate intracranial haemorrhage in patients with mild TBI. Further studies are needed to characterize the risk profile of this drug in patients with tICH.
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: christopher.beynon@med.uni-heidelberg.de.
authors.forename: Christopher
authors.initials: C
authors.lastname: Beynon
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Potzy
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Sakowitz
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Unterberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000601:surgery*; D065427:Factor Xa Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000150:complications / Q000188:drug therapy*; D020300:Intracranial Hemorrhages / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D065427:Factor Xa Inhibitors; D010975:Platelet Aggregation Inhibitors; D000069552:Rivaroxaban
keywords: Anticoagulants, Factor Xa inhibitors, Haemostasis, Intracerebral haemorrhage; Head injury