Warfarin and the apparent minor head injury.

Saab, M; Gray, Andrew; Hodgkinson, D W; Irfan, Muhammad

doi:10.1136/emj.13.3.208

Cited by 50 publications

(27 citation statements)

References 4 publications

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“…Although warfarin use in the general population is increasing, its prevalence is unknown. [2][3][4] Furthermore, the real incidence of brain injury in the population receiving oral anticoagulation cannot be evaluated from this study or others because data on minor trauma are not necessarily collected. However, the risk of intracranial injury was demonstrated to be very low among patients who sustained falls while receiving anticoagulation therapy.…”

Section: Discussionmentioning

confidence: 95%

“…Concurrently, the prescription of warfarin for various diseases has increased steadily in recent years, and more patients receiving warfarin are seen in emergency rooms after trauma. 3,4 Although most authors agree that the risk of intracranial bleeding increases with anticoagulation therapy, 2-4 trauma itself remains an uncommon cause for bleeding. 5 A large majority of intracranial bleeding occurs spontaneously 5,6 and the incidence of intracranial lesions remains low among patients receiving warfarin.…”

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confidence: 99%

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Preinjury Warfarin Use Among Elderly Patients With Closed Head Injuries in a Trauma Center

Lavoie

Ratte

Clas

et al. 2004

The Journal of Trauma: Injury, Infection, and Critical Care

149

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Preinjury Warfarin Use Among Elderly Patients With Closed Head Injuries in a Trauma Center

Lavoie

Ratte

Clas

et al. 2004

The Journal of Trauma: Injury, Infection, and Critical Care

149

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“…In the setting of minor head trauma, OACrelated ICH has been noted. Saab et al 23 reported two cases where minor head injury resulted in surgically significant intracranial bleeding, and suggested that all patients receiving OAC therapy suffering minor head trauma be admitted to the hospital for observation and undergo urgent CT evaluation for persistent symptoms such as headache. Of the two cases reported, the first patient presented 48 hours after injury for evaluation of a severe headache, and the second was noted to have transient posttraumatic amnesia.…”

Section: Discussionmentioning

confidence: 99%

Minor Head Trauma in Anticoagulated Patients

Garra

Nashed

Capobianco

1999

Academic Emergency Medicine

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Abstract. Objective: To determine the incidence of clinically significant intracranial injury in the anticoagulated patient suffering minor head trauma without loss of consciousness (LOC) or acute neurologic abnormality. Methods: A retrospective chart review was performed based on a computerized search of electronic patient records from six community hospital EDs, one of which is a trauma center. Patients taking warfarin who sustained minor head trauma without LOC having no acute neurologic abnormalities treated from January 1994 to January 1996 were identified using a search of electronic ED records. Charts were reviewed for mechanism of injury, physical examination findings of head injury, and concomitant injury. Prothrombin time and head CT results were recorded if obtained. For those patients not receiving a head CT on ED evaluation, telephone follow-up was performed to determine outcome. Results: There were 65 patients meeting inclusion criteria. Thirty-eight patients had prothrombin times obtained, with ranges from 12.0 sec to 30.7 sec. There was no intracranial injury found in any of the 39 patients having a head CT. Additionally, follow-up on the 26 patients who did not undergo CT scanning revealed no evidence of complications related to their head injuries. Conclusions: The incidence of clinically significant intracranial injury is extremely low in the anticoagulated patient suffering minor blunt head trauma without LOC or acute neurologic abnormality. CT scanning may not be necessary in these patients. Larger prospective studies are needed to confirm these findings. Key words: intracranial injury; anticoagulation; minor head trauma. ACA-DEMIC EMERGENCY MEDICINE 1999; 6:121 -124 E VALUATION of the head-injured patient has been long debated.1 -13 While it is clear that all patients who present with signs of neurologic compromise should undergo immediate CT of the head, argument exists over evaluation of the patient with a Glasgow Coma Score (GCS) of 15 and a normal neurologic examination. Several studies suggest the use of CT for all patients sustaining minor head trauma with a brief period of loss of consciousness (LOC), arguing that as many as 3% of patients who are able to talk after a head injury will deteriorate. 1 -5,7 -9,11,12 However, in the absence of LOC and with a normal neurologic examination in the ED, several authors have concluded that CT scanning is unnecessary and such patients may be safely discharged to home. 4,11,13 To our knowledge, there is no literature referring to the evaluation of the anticoagulated patient taking warfarin who suffers minor head trauma. Retrospective studies of hemophiliacs sustaining minor head trauma without LOC and having a normal neurologic examination have demonstrated that CT scanning of the head is unremarkable. 14 -16 We sought to determine the incidence of intracra- METHODSStudy Design. This was a retrospective review of the ED records of anticoagulated patients with minor head injury, presenting from January 1, 1994, to December 31, 1995. Follo...

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“…Generally speaking, there is a lack of consensus regarding the criteria used to define MTBI and several definitions have been proposed in an attempt to differentiate MTBI from moderate or severe TBI [9][10][11][12][13][14][15][16][17][18][19]. Although the various definitions and diagnostic methods make it difficult to achieve accurate incidence rates [7,20], as many as 90% of all TBIs are suspected to be mild [3,21], with three-quarters of these going unreported and unassessed by medical professionals [22].…”

Section: Introductionmentioning

confidence: 99%