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Anticoagulants/antiplatelets Delayed intracranial haemorrhage: 3 case reports

In a single-institution retrospective observational study of 314 patients presented to hospital following blunt head trauma between January 2017 and August 2018, three patients [2 men and 1 woman] aged 81–92 years were described, who developed delayed intracranial haemorrhage during treatment with apixaban, rivaroxaban, aspirin or clopidogrel [not all dosages and routes stated; durations of treatments to reactions onsets and outcomes not stated]. Patient 1: An 81-year-old man, who had been receiving treatment with oral rivaroxaban for atrial fibrillation, presented to the hospital with a blunt head injury following a low-distance fall (fall out of bed). At the time of injury, he had thrombocytopenia. An initial CT scan of the brain was found to be negative for intracranial haemorrhage. After 15h of the initial CT scan, a repeat CT scan of the brain was performed which showed subdural haematoma. Rivaroxaban was discontinued for 10 days following the diagnosis of intracranial haemorrhage. The duration of his hospital stay was 2 days. Patient 2: An 88-year-old man had been receiving treatment with oral apixaban for atrial fibrillation. He had been also receiving antiplatelet therapy with a low-dose aspirin 81 mg/day. He was admitted with syncope and frequent falls after a blunt head injury following a low-distance fall (fall from standing). At the time of injury, he had thrombocytopenia. On admission, physical examination showed facial laceration. An initial CT scan of the brain was found to be negative for intracranial haemorrhage. After 23.5h of the initial CT scan, a repeat CT scan of the brain was performed which showed two subdural hematomas. Apixaban and aspirin were discontinued for 10 days following the diagnosis of intracranial haemorrhage. The duration of his hospital stay was 3 days. Patient 3: A 92-year-old woman had been receiving treatment with oral apixaban for atrial fibrillation. She had been also receiving antiplatelet therapy with clopidogrel [Plavix]. She was admitted for physical and occupational therapy due to a blunt head injury following a low-distance fall (fall from standing). At the time of injury, she had thrombocytopenia. Physical examination showed scalp laceration. An initial CT scan of the brain was found to be negative for intracranial haemorrhage. After 24h of the initial CT scan, a repeat CT scan of the brain was performed which showed subdural haematoma. Apixaban and clopidogrel were discontinued for 10 days following the diagnosis of intracranial haemorrhage. The duration of her hospital stay was 7 days. Soleimani T, et al. Delayed Intracranial Hemorrhage After Blunt Head Injury With Direct Oral Anticoagulants. Journal of Surgical Research 257: 394-398, Jan 2021. Available from: URL: http://doi.org/10.1016/j.jss.2020.08.024

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Reactions 3 Oct 2020 No. 1824