title: Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted.
abstract: Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CT with prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using χ(2) and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P < 0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P < 0.001), were more likely to present with an abnormal neurologic examination (P = 0.004), and had higher hospital and intensive care unit lengths of stay (P < 0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P < 0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona, USA.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Moutamn
authors.initials: M
authors.lastname: Sadoun
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Julie L
authors.initials: JL
authors.lastname: Wynne
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D000077144:Clopidogrel; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin