Irreversible catastrophic brain hemorrhage after minor injury in a patient on dabigatran

Clinicians from the University of Utah report the death of a patient who received a mild brain injury from a ground-level fall while taking the new anticoagulant dabigatran etexilate for non–valve related atrial fibrillation. The authors describe the events that led from a mild traumatic brain injury to the man’s death, the largely irreversible dangers of massive hemorrhage from direct thrombin inhibitors such as dabigatran, and the few management options that can be used to counteract this “uncontrollable” bleeding.

Is aggressive treatment of severe traumatic brain injury cost effective?

Researchers at the Perelman School of Medicine at the University of Pennsylvania have demonstrated that aggressive treatment of severe traumatic brain injury, which includes invasive monitoring of intracranial pressure (ICP) and decompressive craniectomy, produces better patient outcomes than less aggressive measures and is cost-effective in patients no matter their age––even in patients 80 years of age. These important findings can be found in the article “Is aggressive treatment of traumatic brain injury cost-effective? Clinical article,” by Robert Whitmore and colleagues, published online March 6 in the Journal of Neurosurgery.