Emergency Medical Minute11 Jan 2022

Podcast 746: Elderly Head Trauma on Anticoagulation

Contributor: Aaron Lessen, MD

Educational Pearls:

Biggest study to date examined new protocol for repeat head CT in anticoagulated elderly patients with head trauma and an initial negative head CT
- 0.5%-6% of patients in this category will get a delayed ICH and this can occur up to a week out from initial injury
18% of the study group had an ICH on initial head CT, but the rest who had negative head CT initially received a repeat head CT at 6 hours
0.9% had a bleed identified on repeat head CT 6 hours after initial imaging, but of this group no one had an intervention for this bleed
Suggests repeat head CT may not be needed and that good counseling for return precautions and discharge is a reasonable disposition in caring for these patients
Supratherapeutic INR was a risk factor for delayed bleed, so they should be treated as a higher risk group of patients

References

Borst J, Godat LN, Berndtson AE, Kobayashi L, Doucet JJ, Costantini TW. Repeat head computed tomography for anticoagulated patients with an initial negative scan is not cost-effective. Surgery. 2021;170(2):623-627. doi:10.1016/j.surg.2021.02.024

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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