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Anticoagulation in traumatic brain injury

Anticoagulation are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI).

Standard diagnosis and treatment algorithms for patients who sustained mild traumatic brain injury are only partially applicable to anticoagulated patients 1).

Controversy exists regarding the utility of head computed tomography (CT) in allowing safe discharge dispositions for anticoagulated patients suffering minor head injury.

What is the risk of delayed intracranial hemorrhage in anticoagulated patients with minor head injury and a normal initial head CT scan?

Four observational studies were reviewed that investigated the outcomes of anticoagulated patients who presented after minor head injury.

Overall incidence of death or neurosurgical intervention ranged from 0 to 1.1% among the patients investigated. The studies did not clarify which patients were at highest risk.

The literature does not support mandatory admission for all anticoagulated patients after minor head injury, but further studies are needed to identify the higher-risk patients for delayed bleeding to determine appropriate management 2).

A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital anticoagulation therapy. Anticoagulation patients were older (P < 0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P < 0.001), were more likely to present with an abnormal neurologic examination (P = 0.004), and had higher hospital and intensive care unit lengths of stay (P < 0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The Anticoagulation patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P < 0.05). Prehospital Anticoagulation therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information 3).

Jagoda AS, Bazarian JJ, Bruns JJ, Jr., et al. Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Annals of Emergency Medicine. 2008;52(6):714–748.
Cohn B, Keim SM, Sanders AB. Can anticoagulated patients be discharged home safely from the emergency department after minor head injury? J Emerg Med. 2014 Mar;46(3):410-7. doi: 10.1016/j.jemermed.2013.08.107. Epub 2013 Dec 19. Review. PubMed PMID: 24360352.
Joseph B, Sadoun M, Aziz H, Tang A, Wynne JL, Pandit V, Kulvatunyou N, O'Keeffe T, Friese RS, Rhee P. Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted. Am Surg. 2014 Jan;80(1):43-7. PubMed PMID: 24401514.
anticoagulation_in_traumatic_brain_injury.txt · Last modified: 2015/01/03 10:15 (external edit)