Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Salutsantjoan     Gmail     Dropbox     Instagram     Google Drive     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


My photo
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, August 7, 2016

Minor Head Trauma in Anticoagulated Patients

Risk of ICH in Anticoagulated Patients
R.E.B.E.L. EM - Posted by Salim Rezaie - July 20, 2015
"Clinical Take Home Points:
  • Routine head CT in head-injured patients with previous warfarin or clopidogrel use should be performed, even in well-appearing patients regardless of lack of clinical findings
  • Delayed traumatic ICH in patients on therapeutic warfarin and clopidogrel is very rare and these patients may be discharged home after a negative initial head CT, but with explicit discharge instructions and close follow up.
  • 24 hour observation of patients with poor functional capacity, long travel times to get to a hospital, and/or patients with no one at home to watch them would also be an acceptable alternative
  • Patients with therapeutic anticoagulation, blunt head trauma, and a negative initial head CT DO NOT need to have their anticoagulation aggressively reversed
  • Patients with supratherapeutic anticoagulation, blunt head trauma, and a negative initial head CT were not explicitly discussed in this paper, but in my practice, I would have a low threshold to admit them for frequent neuro checks, repeat measurement of INR (while holding anticoagulation), and possibly repeat head CT if any change in exam"