Minor head injury in anticoagulated patients: Outcomes and analysis of clinical predictors. A prospective study

Menditto, V.G.; Moretti, M.; Babini, L.; Sampaolesi, M.; Buzzo, M.; Montillo, L.; Raponi, A.; Riccomi, F.; Marcosignori, M.; Rocchi, M.; Pomponio, G.

doi:10.1016/j.ajem.2023.11.023

Cited by 2 publications

(4 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The progressive exclusion of five risk factors-PTA, post-traumatic TLOC, greater trauma dynamic, GCS < 15, and evidence of trauma above the clavicles-reduced the risk of ICI from 61.4% to 2.5%. Finally, in a recent prospective study [42], we found that only post-traumatic severe headache (OR: 5.10; 95% CI: 1.26-20.75; p = 0.02) and post-traumatic vomiting (OR: 3.44; 95% CI: 1.20-9.89; p = 0.02) correlated with ICI on the first or second head CT scan.…”

Section: Clinical Decision Rulesmentioning

confidence: 62%

“…In the study by Cipriano et al [122], 3 out of 178 anticoagulated patients showed a dICI (1.7%; 95% CI: 0.0-3.6%), and 1 of them died (0.6%; 95% CI: 0.5-1.7%), while the others did not require neurosurgical intervention. In two independent prospective cohorts [11,42], we found an incidence of dICI of 6% and 4.7%, respectively. In the former study [11], 3 patients were subsequently hospitalized and 1 received craniotomy, while, in the latter [42], 17 patients were admitted and no neurosurgery was needed and no death occurred.…”

Section: Delayed Intracranial Injuriesmentioning

confidence: 77%

“…In two independent prospective cohorts [11,42], we found an incidence of dICI of 6% and 4.7%, respectively. In the former study [11], 3 patients were subsequently hospitalized and 1 received craniotomy, while, in the latter [42], 17 patients were admitted and no neurosurgery was needed and no death occurred.…”

Section: Delayed Intracranial Injuriesmentioning

confidence: 77%

“…Recent evidence seems to suggest that the same clinical risk factors extensively studied in mTBI could be used in the first assessment of the subgroup of patients on OAT [33][34][35][36][37][38][39][40][41][42]. In a prospective study, Cipriano et al [33] found that PTA and trauma above the clavicles remain independent predictors for ICI in people on OAT.…”

Section: Clinical Decision Rulesmentioning

confidence: 99%

See 3 more Smart Citations

Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department

Menditto,

Rossetti,

Sampaolesi

et al. 2024

JCM

View full text Add to dashboard Cite

The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric. We reviewed the most recent evidence on these topics and explored other clinically relevant aspects, such as the promising role of dosing brain biomarkers, the strategies to assess the extent of anticoagulation, and the indications of reversals and tranexamic acid administration, in cases of mild TBI or as a bridge to neurosurgery. The appropriate timing of anticoagulant resumption was also discussed. Finally, we obtained an insight into the economic burden of TBI in patients on oral anticoagulants, and future directions on the management of this subpopulation of TBI patients were proposed. In this article, at the end of each section, a “take home message” is stated.

show abstract

Section: Clinical Decision Rulesmentioning

confidence: 62%