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

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domingo, 7 de agosto de 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"