The risks of minor head injury in the warfarinised patient.

Volans, A P

doi:10.1136/emj.15.3.159

Cited by 29 publications

(11 citation statements)

References 15 publications

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“…The following details were obtained from the clinical notes: age; mechanism of injury; presenting symptoms or signs; and the INR level if taken at presentation. The Emergency Department has a low threshold for scanning this cohort of patients, as originally advocated by Volans 4. In our centre, all patients with a significant blow to the head or fall from standing with GCS 15 throughout are normally considered for CT scanning, in addition to those advocated by the NICE guidelines 1.…”

Section: Methodsmentioning

confidence: 99%

“…The early work by Volans4 in his case series study of anticoagulated patients with TBI and ICH found that headache was a common symptom, and he suggested that the threshold for CT scanning should be lower than that recommend by the conventional guidelines of that time. However, the risk of ICH in anticoagulated patients with TBI who present with headache has not been clearly defined.…”

Section: Introductionmentioning

confidence: 99%

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An analysis of predictive markers for intracranial haemorrhage in warfarinised head injury patients

Rendell

Batchelor

2012

Emerg Med J

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An analysis of predictive markers for intracranial haemorrhage in warfarinised head injury patients

Rendell

Batchelor

2012

Emerg Med J

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“…No relationship between bleeding tendency and abnormal CT was found, as bleeding tendency was only examined in 645 of 1,014 patients (64%) in the no CT abnormality group. Coagulopathy has been considered a risk factor for intracranial injury, 9,33) but low-dose aspirin does not increase the risk of intracranial hemorrhage in patients older than 60 years of age. 26) The presence of fracture was only assessed in 59% of our patients, but had a strong influence on intracranial lesions, as previously reported.…”

Section: Ct Indications In Mild Head Injurymentioning

confidence: 99%

Indications for Computed Tomography in Patients With Mild Head Injury

Ono

Wada

Takahara

et al. 2007

Neurol. Med. Chir.(Tokyo)

137

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The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46 ± 23 years), with mild head injury (Glasgow Coma Scale [GCS] score AE14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r ＝ 0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age AE60 years, male sex, JCS score AE1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score À0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age AE60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n ＝ 21) or patient request (n ＝ 17). These indications for CT including JCS may be useful in the management of patients with mild head injury.

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“…However, patients under oral anticoagulation may still be at risk for severe bleeding secondary to minor trauma [17][18][19]. These patients should lower the threshold for more complete diagnostic evaluations on their arrival at the emergency department.…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic Acute Cholecystitis Caused by Intra-Gallbladder Hemorrhage in a Patient with Anticoagulant Therapy

Kirshtein

Lantsberg

Duchno

et al. 2002

European Journal of Trauma

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Background: With aging of the population, the incidence of trauma victims who are on anticoagulant or antiplatelet treatment is increasing. These patients are at risk of serious hemorrhage even after relatively minor trauma. They can also show bleeding in unusual locations with unusual consequences. Case Study: We report a previously undocumented bleeding complication in an anticoagulated patient, namely a delayed presentation of acute cholecystitis, where cystic duct obstruction was due to bleeding into the gallbladder after blunt abdominal trauma.

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The risks of minor head injury in the warfarinised patient.

Cited by 29 publications

References 15 publications

An analysis of predictive markers for intracranial haemorrhage in warfarinised head injury patients

An analysis of predictive markers for intracranial haemorrhage in warfarinised head injury patients

Indications for Computed Tomography in Patients With Mild Head Injury

Posttraumatic Acute Cholecystitis Caused by Intra-Gallbladder Hemorrhage in a Patient with Anticoagulant Therapy

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