Mild brain injury and anticoagulants: Less is enough

doi:10.1212/CPJ.0000000000000375

. 2017 Aug;7(4):296-305.

doi: 10.1212/CPJ.0000000000000375.

Mild brain injury and anticoagulants: Less is enough

Laura Campiglio¹, Francesca Bianchi¹, Claudio Cattalini¹, Daniela Belvedere¹, Chiara Emilia Rosci¹, Chiara Livia Casellato¹, Manuela Secchi¹, Maria Cristina Saetti¹, Elena Baratelli¹, Alessandro Innocenti¹, Ilaria Cova¹, Chiara Gambini¹, Luca Romano¹, Gaia Oggioni¹, Rossella Pagani¹, Marco Gardinali¹, Alberto Priori¹

Affiliations

Affiliation

¹ III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.

PMID: 29185534
PMCID: PMC5648198
DOI: 10.1212/CPJ.0000000000000375

Mild brain injury and anticoagulants: Less is enough

Laura Campiglio et al. Neurol Clin Pract. 2017 Aug.

. 2017 Aug;7(4):296-305.

doi: 10.1212/CPJ.0000000000000375.

Authors

Affiliation

¹ III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.

PMID: 29185534
PMCID: PMC5648198
DOI: 10.1212/CPJ.0000000000000375

Abstract

Background: Despite the higher theoretical risk of traumatic intracranial hemorrhage (ICH) in anticoagulated patients with mild head injury, the value of sequential head CT scans to identify bleeding remains controversial. This study evaluated the utility of 2 sequential CT scans at a 48-hour interval (CT1 and CT2) in patients with mild head trauma (Glasgow Coma Scale 13-15) taking oral anticoagulants.

Methods: We retrospectively evaluated the clinical records of all patients on chronic anticoagulation treatment admitted to the emergency department for mild head injury.

Results: A total of 344 patients were included, and 337 (97.9%) had a negative CT1. CT2 was performed on 284 of the 337 patients with a negative CT1 and was positive in 4 patients (1.4%), but none of the patients developed concomitant neurologic worsening or required neurosurgery.

Conclusions: Systematic routine use of a second CT scan in mild head trauma in patients taking anticoagulants is expensive and clinically unnecessary.

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Figures

**Figure. Temporal bleeding at CT2**
Detection of a small temporopolar bleeding at CT2 in a 42-year-old patient admitted after mild traumatic brain injury due to assault. He was under anticoagulant therapy with warfarin. International normalized ratio at admission was 2.93.

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Comment in

Head injury while on anticoagulation: Small numbers, big risks.
Nearing KI, Tsao JW. Nearing KI, et al. Neurol Clin Pract. 2017 Aug;7(4):280-282. doi: 10.1212/CPJ.0000000000000385. Neurol Clin Pract. 2017. PMID: 29185531 Free PMC article. No abstract available.

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References

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[1] Peeters W, van den Brande R, Polinder S, et al. . Epidemiology of traumatic brain injury in Europe. Acta Neurochir 2015;157:1683–1696. - PMC - PubMed

[2] Peeters W, van den Brande R, Polinder S, et al. . Epidemiology of traumatic brain injury in Europe. Acta Neurochir 2015;157:1683–1696. - PMC - PubMed

[3] Olsen J, Gustavvson A, Svensson M. The economic cost of brain disorder in Europe. Eur J Neurol 2012;19:155–162. - PubMed

[4] Olsen J, Gustavvson A, Svensson M. The economic cost of brain disorder in Europe. Eur J Neurol 2012;19:155–162. - PubMed

[5] Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

[6] Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

[7] The Management of Concussion/mTBI Work Group. VA/DoD Clinical Practice Guideline: Management of Concussion/Mild Traumatic Brain Injury. Available at: https://www.healthquality.va.gov/guidelines/Rehab/mtbi/concussion_mtbi_f.... Accessed February 14, 2012.

[8] The Management of Concussion/mTBI Work Group. VA/DoD Clinical Practice Guideline: Management of Concussion/Mild Traumatic Brain Injury. Available at: https://www.healthquality.va.gov/guidelines/Rehab/mtbi/concussion_mtbi_f.... Accessed February 14, 2012.

[9] American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86Y87.

[10] American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86Y87.

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Mild brain injury and anticoagulants: Less is enough

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