Published in the Journal of Neurosurgery, researchers from the Delray Medical Trauma Center in Delray Beach, Florida, reviewed the records of adults brought into the emergency room with a head injury from a fall between February and May 2011. These were “closed” head injuries meaning the trauma was seen internally and the patients were not bleeding from a superficial wound.
Patients were taking the anticoagulant Coumadin (warfarin, 15 patients), Pradaxa (five patients) or were not taking any blood thinners (25 patients).
Since there is essentially no effective antidote to Pradaxa it is not surprising that the authors found new or progressive hemorrhages among those patients on Pradaxa when compared to warfarin. Two of the patients taking Pradaxa died from internal cranial hemorrhages that could not be stopped. Meanwhile, none of those patients taking Coumadin or among the no-anticoagulant group died from their head trauma.
The researchers say their goal is not to point fingers but to point out to emergency physicians that it is a race against time when a patient is on Pradaxa and has suffered a head injury from a fall.
In the other report, published in Neurosurgical Focus, researchers from Massachusetts General Hospital and Harvard Medical School reviewed the difficulties of reversing the anticoagulant effects of Pradaxa and the potential for a fatal outcome after an intracranial hemorrhage.
Often those at most risk are the elderly who may be less steady on their feet. Even a mild head injury can result in an uncontrolled hemorrhage. When researchers tried administering vitamin K, which reverses the effects of warfarin (Coumadin), it did nothing to stop the uncontrolled bleeding from Pradaxa and the patient cited died from his head injuries.
In the case of an 85-year-old woman who needed surgery to remove a subdural hematoma, the surgery had to wait until the drug was cleared out of her system, which took three days. That patient had a successful outcome, but how many patients in an emergency situation can afford to wait for three days?
The lead author concludes that Pradaxa’s use should be limited among the population at risk for falls because of the lack of a reversal agent.