Utility of INR For Prediction of Delayed Intracranial Hemorrhage Among Warfarin Users with Head Injury

Valiuddin, Hisham; Alam, Ariful; Calice, Michael; Boehm, Kevin M; Millard, John; Laforest, Daniel; Valiuddin, Yaser; Ricardi, Rick; Kaakaji, Rami; Koch, Spencer; Oweis, Thomas; Keyes, Daniel C.

doi:10.1016/j.jemermed.2020.01.003

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…In a study conducted by Schoonman et al (10), patients developing delayed ICH, were on VKA (n=5) and three of them had a supratherapeutic level of INR (>3). Patients with delayed ICH may have a normal INR level (defined as between 2-3) (27). Studies have shown that delayed bleeding may occur in patients with head trauma, whose INR value is in the therapeutic range (4,8).…”

Section: Discussionmentioning

confidence: 99%

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Do We Need to Repeat the Initially Normal Head Computerized Tomography for Patients with Mild Head Trauma Using Anticoagulant and/or Antiplatelet Therapy?

ÇATAL

Günalp

Genç

et al. 2023

Konuralp Tıp Dergisi

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Objective: Patients using anticoagulant and/or antiplatelet (AC/AP) medications are at an increased risk of intracranial hemorrhage (ICH) subsequent to head trauma and current guidelines recommend a head computed tomography (CT) scan for these patients. There is a lack of consensus about management recommendations for mild head trauma patients on AC/AP treatment who had an initially normal head CT. The aim of this study was to determine the rate of delayed ICH after a 24-hour observation in patients with mild head trauma using AC/AP who had an initially normal head CT. Method: Patients aged 18 and older, using AC/AP drugs with mild head trauma were included prospectively. Patients underwent head CT for suspected bleeding. A repeat CT scan was performed after a 24-hours observation period for the patients who had an initially normal head CT for detecting delayed intracranial hemorrhage. Result: A total of 101 patients were included and, 57.4% (n=58) of the patients were female. Delayed ICH was detected in 2.9% (n=3) of the patients after a 24-hour observation. None of the patients with delayed ICH needed surgical treatment or further intervention. Delayed ICH was found in patients who used acetylsalicylic acid (n=1), dabigatran (n=1), and apixaban (n=1). Conclusion: In patients with mild head trauma using AC/AP, delayed intracranial hemorrhage is rare and may be clinically insignificant. A repeat CT scanning after 24-hour observation may not be necessary for patients with mild head trauma using AC/AP therapy who had initially normal head CT.

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Section: Discussionmentioning

confidence: 99%

“…In our study, three patients with delayed ICH had a normal range of INR values. Using INR level for risk stratification of brain injury patients on VKA has been suggested however, resulting data should be interpreted rigorously considering the limited number of reported delayed ICH patients in these studies (26,27).…”

Section: Discussionmentioning

confidence: 99%

Do We Need to Repeat the Initially Normal Head Computerized Tomography for Patients with Mild Head Trauma Using Anticoagulant and/or Antiplatelet Therapy?

ÇATAL

Günalp

Genç

et al. 2023

Konuralp Tıp Dergisi

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“…Despite the variables mentioned above, storage time and temperature between specimen collection and analysis were essential factors that affect PT/INR assay results (Toulon et al, 2017). It is identified that, in less than 25% of the patients, the INR values could be changed >10% by 6 hours post blood collection when the sample is stored at room temperature or 4-6 o C. Further delays of more than 24 hours could change INR by >10% in more than 25% of patients' samples (Valiuddin et al, 2020;Geest-Daalderop et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Effect of Time and Temperature Variables on Prothrombin Time and International Normalized Ratio of Plasma in Patients in Gampaha, Sri Lanka

Ranasinghe

Jayasundara

Sılva³

et al. 2022

Med.Lab.Tech.J.

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Generating accurate results for Prothrombin time (PT) and International Normalized Ratio (INR), PT/INR test is paramount in treatment monitoring. The diagnosis process measures how long it takes blood to clot. The main objective of this study was to determine the effect of storage time and temperature variables on PT and INR results in patients attending Hematologic clinics in Sri Lanka. This cross-sectional study was conducted during June and July 2021. PT was measured in the plasma samples, stored at different temperatures at baseline (0 hours), and then after 12 hours, 18 hours, and 24 hours after specimen collection. INR was calculated from each result, and the deviation percentage of PT and INR was calculated compared to the baseline result (0 hours). Then PT and INR percentage deviation is grouped as <10% and >10% to find biologically significant variations while paired t-test was performed to find statistical significance using GraphPad prism 8.4.3. At refrigerated temperature, both PT and INR results showed>10% variation once kept 24 hours, and this variation was statistically significant (p<0.01, Wilcoxon matched paired sign ranked test). The plasma specimens kept at laboratory temperature and specimen collection room temperature for 18 hours indicated >10% variation of PT and INR values, while these variations were significant at the same criteria above. These results suggest that the separated plasma could only be recommended to test up to 12 hours. Therefore, the laboratories that operate in the same climatic conditions can now use these results to plan the specimen collection accordingly.

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Increased relative risk of delayed hemorrhage in patients taking anticoagulant/antiplatelet medications with concurrent aspirin therapy: implications for clinical practice based on 3-year retrospective analysis in a large health system

Chang

Yin

et al. 2022

Emerg Radiol

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Utility of INR For Prediction of Delayed Intracranial Hemorrhage Among Warfarin Users with Head Injury

Cited by 7 publications

References 22 publications

Do We Need to Repeat the Initially Normal Head Computerized Tomography for Patients with Mild Head Trauma Using Anticoagulant and/or Antiplatelet Therapy?

Do We Need to Repeat the Initially Normal Head Computerized Tomography for Patients with Mild Head Trauma Using Anticoagulant and/or Antiplatelet Therapy?

Effect of Time and Temperature Variables on Prothrombin Time and International Normalized Ratio of Plasma in Patients in Gampaha, Sri Lanka

Increased relative risk of delayed hemorrhage in patients taking anticoagulant/antiplatelet medications with concurrent aspirin therapy: implications for clinical practice based on 3-year retrospective analysis in a large health system

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