The utility of a second head CT scan after a negative initial CT scan in head trauma patients on new direct oral anticoagulants (DOACs)

Mourad, Maha; Senay, Ayla; Kharbutli, Bilal

doi:10.1016/j.injury.2021.05.039

Cited by 9 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prevalence rate of dICH ranges between 1%-4.5%. 29,30,34,42,[46][47][48] A similar incidence is described in the subgroup of patients treated with DOACs (0.95%-2.1%). 49,50 In a recent publication by Soleimani et al, only 3 patients above 314 experienced a dICH and they have all been discharged in a week at most.…”

Section: Should the Head Ct Scan Be Repeated?supporting

confidence: 61%

The state of the art of the management of anticoagulated patients with mild traumatic brain injury in the Emergency Department

et al. 2022

View full text Add to dashboard Cite

The effects of Oral Anticoagulation Therapy (OAT) in older patients who suffered a mild Traumatic Brain Injury (mTBI) are widely debated but still strong guidelines are lacking and clinical approaches and management are sometimes heterogeneous. Different predictors of adverse outcomes were identified in the literature but their use in the decision-making process is unclear. Moreover, there is no consensus on the appropriate length of stay in the Observation Unit nor on the continuation of OAT, even if the diagnosis of life-threatening delayed post-traumatic Intracranial Hemorrhage is rare. The recurrence of a control CT scan is often needless. This review aims to summarize recent scientific literature focusing on patients with mTBI taking OAT and to identify crucial questions on the topic to suggest a best clinical practice.

show abstract

Section: Should the Head Ct Scan Be Repeated?supporting

confidence: 61%

The state of the art of the management of anticoagulated patients with mild traumatic brain injury in the Emergency Department

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The latest meta-analysis by Puzio et al, conducted after the introduction of direct oral anticoagulant (DOAC) therapies, reported a 2.3% incidence of d-ICH in patients treated with OAC who suffered a blunt head injury 21 . However, several more recent studies, re ecting the increased useof DOACs compared to warfarin, generally suggest incidence rates of ≤ 1% 22,23,[23][24][25] . The variance in incidence rates between studies could be attributed not only to differences in follow-up methodology but also to misdiagnosis.…”

Section: Resultsmentioning

confidence: 99%

“…Puzio et al's meta-analysis indicated a crude risk of death from d-ICH at 0.33% and d-ICH-related neurosurgical interventions at 0.13% 1 . Several newer studies have shown that important interventions, such as neurosurgery, is extremely rare, with many reporting no neurosurgical interventions across various patient populations14,16,[22][23][24][25] . This aligns with the results of our study, where we found no d-ICH related neurosurgical interventions (0.…”

mentioning

confidence: 99%

The prevalence of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants is very low: a retrospective cohort register study

André,

Björkelund,

Ekelund

et al. 2024

Preprint

View full text Add to dashboard Cite

Background Current guidelines from Scandinavian Neuro Committee mandate a 24-hour observation for head trauma patients on anticoagulants, even with normal initial head CT scans, as a means not to miss delayed intracranial hemorrhages. This study aimed to assess the prevalence, and time to diagnosis, of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants. Method Utilizing comprehensive two-year data from Region Skåne’s emergency departments, which serve a population of 1.3 million inhabitants, this study focused on adult head trauma patients prescribed oral anticoagulants. We identified those with intracranial hemorrhage within 30 days, defining delayed intracranial hemorrhage as a bleeding not apparent on their initial CT head scan. These cases were further defined as clinically relevant if associated with mortality, any intensive care unit admission, or neurosurgery. Results Out of the included 2,362 head injury cases (median age 84, 56% on a direct acting oral anticoagulant), five developed delayed intracranial hemorrhages. None of these five cases underwent neurosurgery nor were admitted to an intensive care unit. Only two cases (0.08%, 95% confidence interval [0.01–0.3%]) were classified as clinically relevant, involving subdural hematomas in patients aged 82 and 87 years, who both subsequently died. The diagnosis of these delayed intracranial hemorrhages was made at 4 and 7 days following initial presentation to the emergency department. Conclusion In patients with head trauma, on oral anticoagulation, the incidence of clinically relevant delayed intracranial hemorrhage was found to be less than one in a thousand, with detection occurring four days or later after initial presentation. This challenges the effectiveness of the 24-hour observation period recommended by the Scandinavian Neurotrauma Committee guidelines, suggesting a need to reassess these guidelines to optimise care and resource allocation. Trial registration This is a retrospective cohort study, does not include any intervention, and has therefore not been registered.

show abstract

“…Many studies and algorithms consider a history of preinjury aspirin use to be low risk for the development of ICH 35 . A recent study demonstrated that a history of DOAC use, along with the GCS (≤13) and a higher injury severity score were associated with an increased risk of delayed ICH 53 . While no consensus exists regarding repeat imaging, the current American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) Best Practice Guidelines in Imaging has published specific recommendations to guide patient management for older adults with a history of antithrombotic use 54 (Fig.…”

Section: Diagnostic Studiesmentioning

confidence: 99%

Management of Traumatic Brain Injury in Older Adults: What You Need to Know

Ghneim,

Stein

2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

Older adults represent the fastest growing population in the United States (US) and this portion of the population is expected to double to more than 80 million by 2050.1 Currently, older adults have more active lifestyles, therefore are at an increased risk of injury.2 Older adults currently represent 23% of trauma admissions.3 This number is projected to increase to 39% by 2050.3 In fact, over the last decade, unintentional injuries have climbed from the 9th to the 7th leading cause of death among older adults. Traumatic brain injury (TBI) accounts for over 200,000 cases annually.4 The consequences of TBI in older adults are severe with high mortality rates5 and significant cognitive and functional impairment for survivors.6–8 Many who were previously independent in their daily activities become dependent on assistance after sustaining a TBI.2 Moreover, older adults experience accelerated cognitive decline, sleep disturbances, and depression following a TBI, which can further hinder their recovery.9 The financial impact of TBI on patients, caregivers, and the health care system is substantial, with annual hospital charges exceeding 8.2 billion for the treatment of TBI in older adults.10 This review aims to highlight the specific considerations and challenges faced by older adults with TBI.

show abstract

The utility of a second head CT scan after a negative initial CT scan in head trauma patients on new direct oral anticoagulants (DOACs)

Cited by 9 publications

References 23 publications

The state of the art of the management of anticoagulated patients with mild traumatic brain injury in the Emergency Department

The state of the art of the management of anticoagulated patients with mild traumatic brain injury in the Emergency Department

The prevalence of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants is very low: a retrospective cohort register study

Management of Traumatic Brain Injury in Older Adults: What You Need to Know

Contact Info

Product

Resources

About