Traumatic intracranial hemorrhage in patients taking dabigatran: report of 3 cases and review of the literature

Neurosurgery. 2013 Aug;73(2):E368-73; discussion E373-4. doi: 10.1227/01.neu.0000430763.95349.5f.


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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Accidental Falls
  • Aged
  • Antithrombins / adverse effects*
  • Atrial Fibrillation / drug therapy
  • Benzimidazoles / adverse effects*
  • Craniocerebral Trauma / complications*
  • Dabigatran
  • Female
  • Humans
  • Intracranial Hemorrhages / etiology*
  • Male
  • beta-Alanine / adverse effects
  • beta-Alanine / analogs & derivatives*


  • Antithrombins
  • Benzimidazoles
  • beta-Alanine
  • Dabigatran