Management of Minor Head Injury in Patients Receiving Oral Anticoagulant Therapy: A Prospective Study of a 24-Hour Observation Protocol“
Menditto V et al.
doi:10.1016/j.annemergmed.2011.12.003
Patients taking warfarin, a blood thinner widely prescribed to prevent blood clots from forming, who suffer minor head injury and have a negative CT scan should have another CT scan after 24 hours, according to the results of an Italian study published online Friday in Annals of Emergency Medicine
“This protocol will identify most occurrences of delayed bleeding in these patients,” said Dr. Vincenzo Menditto of the Ospedali Riuniti di Ancona in Ancona, Italy. “This is particularly true of patients who are 65 years old or older. Patients on warfarin whose INR level is higher than 3.0 are at even higher risk.”
Researchers enrolled 87 emergency department patients with minor head injury who were taking warfarin. Twenty-four hours after having a negative CT scan, five of the patients showed hemorrhage lesions on a repeat CT scan. Three of those patients were admitted to the hospital and one underwent craniotomy for a subdural hematoma, or bleeding in the brain.
An additional two patients who were discharged from the hospital after two negative CT scans were subsequently admitted to the hospital with symptomatic subdural hematomas. Altogether four of the patients with delayed bleeding had an initial INR level of greater than 3.0.
"Our study confirms the recommendation of the European Federation of Neurological Societies,” said Dr. Menditto. “It recommends that all minor head injury patients on blood thinners should have an initial CT scan followed by admission for observation followed by a second CT scan before discharge. This is important for the growing portion of the population that is 65 or older and on blood thinners.”