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  • Title: Traumatic intracranial hemorrhage in patients taking dabigatran: report of 3 cases and review of the literature.
    Author: Wassef SN, Abel TJ, Grossbach A, Viljoen SV, Jackson AW, Howard MA, Greenlee JD.
    Journal: Neurosurgery; 2013 Aug; 73(2):E368-73; discussion E373-4. PubMed ID: 23670031.
    Abstract:
    BACKGROUND AND IMPORTANCE: Dabigatran is a direct thrombin inhibitor gaining popularity as a stroke prevention agent in patients with atrial fibrillation. In comparison with warfarin, dabigatran showed superiority in stroke prevention, but lower rates of major hemorrhage and intracerebral hemorrhage. Although warfarin has a well-established reversal strategy, there is far less experience reversing dabigatran. CLINICAL PRESENTATION: We present our experience with 3 patients who experienced an intracranial hemorrhage either spontaneously or after low-energy cranial trauma and review the available literature describing dabigatran use in patients with traumatic brain injury. CONCLUSION: Intracranial hemorrhage in patients taking anticoagulants and/or antiplatelets can have either a benign or malignant clinical course. At this time, there is little experience with dabigatran reversal; however, several strategies for rapid reversal have been proposed. All patients with intracranial hemorrhage taking dabigatran should be admitted for close neurological monitoring and serial imaging.
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