Highlights
- •Thromboelastography (TEG) does not reliably assess novel oral anticoagulants (NOAC)-related coagulopathy in traumatic brain injury patients.
- •Caution should be used when utilizing TEG to assess anticoagulation status.
- •The development of a NOAC specific assay is needed to improve the accuracy of TEG.
- •PCC4 administration may not be necessary for patients with a traumatic brain injury on NOAC therapy.
Abstract
Introduction
Novel oral anticoagulants (NOACs) have gained popularity as a vitamin K antagonist
alternative without regular monitoring. There has been an increase in elderly patients
on NOACs admitted for traumatic brain injury (TBI). The aim of this study is to determine
the efficacy of thromboelastography (TEG) in detecting NOAC-related coagulopathy among
TBI patients.
Methods
A retrospective chart review of 456 TBI patients admitted to Sentara Norfolk General
Hospital from 2015 to 2020 was performed. Inclusion criteria comprised patients on
NOACs with a TEG performed at presentation (66 patients). Analysis included TEG values,
use of prothrombin complex concentrate factor 4 (PCC4), increased intracranial hemorrhage
on repeat head computed tomography within 24 h of admission, and mortality.
Results
TEG results showed 0% elevated reaction time, 1.5% elevated kinetics time, 1.5% low
alpha angle, 4.5% low max amplitude, and 3.0% elevated clot lysis percent at 30 min
in our cohort. Despite overwhelmingly normal TEG results, 42.42% of patients received
PCC4. A subset analysis of these patients compared to those who did not receive PCC4,
revealed a higher frequency of increased intracranial hemorrhage on repeat head computed
tomography within 24 h of admission (42.86% versus 18.42%, P = 0.03), and increased mortality (25.0% versus 5.26%, P = 0.0219). Patients who did not receive PCC4 had no increased frequency of operative
intervention or worsening of Glasgow Coma Score.
Conclusions
Results suggest that TEG does not reliably assess NOAC-related coagulopathy in TBI
patients. Caution must be used when interpreting TEG data to determine reversal strategies
in TBI patients on NOACs.
Keywords
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Article info
Publication history
Published online: November 23, 2022
Accepted:
September 15,
2022
Received in revised form:
August 16,
2022
Received:
March 2,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
