Risk of delayed head bleed on warfarin

Short Attention Span Summary

How many delayed head bleeds?
This meta-analysis found that the rate of delayed intracranial bleed in patients on warfarin 24 hours after an initially normal head CT was 0.6% and risk for surgery or death was 0.13%.

Spoon Feed
The risk of delayed bleed is very low - even if taking warfarin.  The patients who need special attention are those who are discharged to live alone.  The authors also say to be careful in patients with, "serious mechanism of injury, patients showing signs of neurologic deterioration, and patients presenting with excessive anticoagulation or receiving antiplatelet co-medication."

EM Docs has a good review of anticoagulated patients with head trauma.


Abstract

J Emerg Med. 2016 Jul 26. pii: S0736-4679(16)30175-5. doi: 10.1016/j.jemermed.2016.05.045. [Epub ahead of print]

Risk of Delayed Intracranial Hemorrhage in Anticoagulated Patients with Mild Traumatic Brain Injury: Systematic Review and Meta-Analysis.

Chauny JM1, Marquis M2, Bernard F3, Williamson D4, Albert M3, Laroche M5, Daoust R1.

Author information:

1Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.

2Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.

3Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Critical Care, Hôpital du Sacré-Coeur de Montréal Research Center, Montreal, Quebec, Canada.

4Department of Pharmacy, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.

5Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.

Abstract

BACKGROUND:

Delayed intracranial hemorrhage is a potential complication of head trauma in anticoagulated patients.

OBJECTIVE:

Our aim was to use a systematic review and meta-analysis to determine the risk of delayed intracranial hemorrhage 24 h after head trauma in patients who have a normal initial brain computed tomography (CT) scan but took vitamin K antagonist before injury.

METHODS:

EMBASE, Medline, and Cochrane Library were searched using controlled vocabulary and keywords. Retrospective and prospective observational studies were included. Outcomes included positive CT scan 24 h post-trauma, need for surgical intervention, or death. Pooled risk was estimated with logit proportion in a random effect model with 95% confidence intervals (CIs).

RESULTS:

Seven publications were identified encompassing 1,594 patients that were rescanned after a normal first head scan. For these patients, the pooled estimate of the incidence of intracranial hemorrhage on the second CT scan 24 h later was 0.60% (95% CI 0-1.2%) and the resulting risk of neurosurgical intervention or death was 0.13% (95% CI 0.02-0.45%).

CONCLUSIONS:

The present study is the first published meta-analysis estimating the risk of delayed intracranial hemorrhage 24 h after head trauma in patients anticoagulated with vitamin K antagonist and normal initial CT scan. In most situations, a repeat CT scan in the emergency department 24 h later is not necessary if the first CT scan is normal. Special care may be required for patients with serious mechanism of injury, patients showing signs of neurologic deterioration, and patients presenting with excessive anticoagulation or receiving antiplatelet co-medication.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27473443 [PubMed - as supplied by publisher]