title: The impact of antithrombotic therapy on neurosurgical emergency referral load.
abstract: The authors sought to determine the impact of antithrombotic therapy on emergency referrals at one neurosurgical centre. All emergency telephone referrals over a 90 day period were carefully documented with particular attention paid to current antithrombotic medications and their indication. Details regarding age, gender, diagnosis, radiological findings and treatment were also recorded. 713 emergency referrals were documented in the data collection period. 174 (24.4%) patients presented with intracranial or spinal haemorrhage and 75 (43.1%) of these were on antithrombotic therapy, ranging in age from 46-94 years (mean 71.1 years) with 29 (31.8%) on warfarin, 43 (47.2%) on aspirin and 15 (16.4%) on clopidogrel alone or in combination with another antithrombotic agent. 17 (22.6%) had no documented indication for antithrombotic therapy (all of these were on aspirin therapy) and 9 (31%) of those on warfarin had an INR in excess of 3.5 on presentation. Almost one quarter of those on antithrombotic therapy who presented with a haemorrhagic complication had no obvious indication for such therapy. One third of those on warfarin were over anticoagulated.
authors.affiliation: Department of Neurosurgery, Beaumont Hospital, Beaumont Road Dublin 9.
authors.forename: J
authors.initials: J
authors.lastname: Caird
authors.forename: E
authors.initials: E
authors.lastname: Ayekun
authors.forename: C
authors.initials: C
authors.lastname: Nolan
authors.forename: J
authors.initials: J
authors.lastname: Nagaria
authors.forename: J
authors.initials: J
authors.lastname: Phillips
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation; D016526:Workload
chemical_list: D005343:Fibrinolytic Agents