Cranial CT is a mandatory tool to exclude asymptomatic cerebral hemorrhage in elderly patients on anticoagulation

Schindler, Cora Rebecca; Best, Alicia L.; Woschek, Mathias; Verboket, René D.; Marzi, Ingo; Eichler, Katrin; Störmann, Philipp

doi:10.3389/fmed.2023.1117777

Cited by 4 publications

(1 citation statement)

References 24 publications

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“…The clinical needs and status of currently used fluid-based protein biomarkers using the examples of neural injury markers are summarized in Table 2 and examples of the sensitivity and specificity of the selected legacy protein TBI markers are listed in Table 3. While the list of desirable factors seems very stringent or potentially impossible to achieve, in relation to protein biomarkers, however, if one were to consider the CT head for post traumatic hemorrhage [134,135], it would fulfil all of them.…”

Section: Protein Biomarkers In Clinical Tbi; Current Status and Unmet...mentioning

confidence: 99%

Fluid-Based Protein Biomarkers in Traumatic Brain Injury: The View from the Bedside

Agoston,

Helmy

2023

IJMS

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There has been an explosion of research into biofluid (blood, cerebrospinal fluid, CSF)-based protein biomarkers in traumatic brain injury (TBI) over the past decade. The availability of very large datasets, such as CENTRE-TBI and TRACK-TBI, allows for correlation of blood- and CSF-based molecular (protein), radiological (structural) and clinical (physiological) marker data to adverse clinical outcomes. The quality of a given biomarker has often been framed in relation to the predictive power on the outcome quantified from the area under the Receiver Operating Characteristic (ROC) curve. However, this does not in itself provide clinical utility but reflects a statistical association in any given population between one or more variables and clinical outcome. It is not currently established how to incorporate and integrate biofluid-based biomarker data into patient management because there is no standardized role for such data in clinical decision making. We review the current status of biomarker research and discuss how we can integrate existing markers into current clinical practice and what additional biomarkers do we need to improve diagnoses and to guide therapy and to assess treatment efficacy. Furthermore, we argue for employing machine learning (ML) capabilities to integrate the protein biomarker data with other established, routinely used clinical diagnostic tools, to provide the clinician with actionable information to guide medical intervention.

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Section: Protein Biomarkers In Clinical Tbi; Current Status and Unmet...mentioning

confidence: 99%

Fluid-Based Protein Biomarkers in Traumatic Brain Injury: The View from the Bedside

Agoston,

Helmy

2023

IJMS

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Higher risk of traumatic intracranial hemorrhage with antiplatelet therapy compared to oral anticoagulation—a single-center experience

Niklasson,

Svensson,

André

et al. 2024

Eur J Trauma Emerg Surg

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Purpose Traumatic brain injury is the main reason for the emergency department visit of up to 3% of the patients and a major worldwide cause for morbidity and mortality. Current emergency management guidelines recommend close attention to patients taking oral anticoagulation but not patients on antiplatelet therapy. Recent studies have begun to challenge this. The aim of this study was to determine the impact of antiplatelet therapy and oral anticoagulation on traumatic intracranial hemorrhage. Methods Medical records of adult patients triaged with “head injury” as the main reason for emergency care were retrospectively reviewed from January 1, 2017, to December 31, 2017, and January 1, 2020, to December 31, 2021. Patients ≥ 18 years with head trauma were included. Odds ratio was calculated, and multiple logistic regression was performed. Results A total of 4850 patients with a median age of 70 years were included. Traumatic intracranial hemorrhage was found in 6.2% of the patients. The risk ratio for traumatic intracranial hemorrhage in patients on antiplatelet therapy was 2.25 (p < 0.001, 95% confidence interval 1.73–2.94) and 1.38 (p = 0.002, 95% confidence interval 1.05–1.84) in patients on oral anticoagulation compared to patients without mediations that affect coagulation. In binary multiple regression, antiplatelet therapy was associated with intracranial hemorrhage, but oral anticoagulation was not. Conclusion This study shows that antiplatelet therapy is associated with a higher risk of traumatic intracranial hemorrhage compared to oral anticoagulation. Antiplatelet therapy should be given equal or greater consideration in the guidelines compared to anticoagulation therapy. Further studies on antiplatelet subtypes within the context of head trauma are recommended to improve the guidelines’ diagnostic accuracy.

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Incidence of intracranial bleeding in mild traumatic brain injury patients taking oral anticoagulants: a systematic review and meta-analysis

Karamian,

Seifi,

Karamian

et al. 2024

J Neurol

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Cranial CT is a mandatory tool to exclude asymptomatic cerebral hemorrhage in elderly patients on anticoagulation

Cited by 4 publications

References 24 publications

Fluid-Based Protein Biomarkers in Traumatic Brain Injury: The View from the Bedside

Fluid-Based Protein Biomarkers in Traumatic Brain Injury: The View from the Bedside

Higher risk of traumatic intracranial hemorrhage with antiplatelet therapy compared to oral anticoagulation—a single-center experience

Incidence of intracranial bleeding in mild traumatic brain injury patients taking oral anticoagulants: a systematic review and meta-analysis

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