Rivaroxaban and intracranial haemorrhage after mild traumatic brain injury: A dangerous combination?

• Novel anticoagulants such as rivaroxaban are increasingly prescribed.
• We retrospectively analyze patients with mild TBI and intracranial haemorrhage.
• Rivaroxaban treatment increased mortality and rate of re-haemorrhage.
• Lack of specific antidotes may contribute to unfavourable outcome.

ObjectivesDespite 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).MethodsA 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.ResultsNo 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.ConclusionsDespite 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.