Mild traumatic brain injury with anticoagulation

Traumatic brain injury (TBI) with concomitant anticoagulation (AC) is a common presentation in emergency departments, especially as the average age of the population is rising entailing an increasing number of co-morbidities requiring AC. Although minor head trauma (MHT) under AC is a common entity the literature remains controversial with regard to imaging and treatment. An evidence-based review of the risk of intracranial bleeding (ICB) in MHT under AC was carried out. A systemic analysis of the current literature from 1992 to 2010 listed in Pubmed and Medline was performed using the keywords "minimal, minor or mild traumatic brain injury" in combination with "aspirin, clopidogrel, coumadin, warfarin or coagulopathy". Exclusion criteria comprised spontaneous, non-traumatic ICB and studies including less than 50 patients. A total of 18 studies met the inclusion criteria and revealed that elderly patients under AC suffer more frequently from mild head trauma due to falls. Of these 2 prospective studies dealt with the question of a control cranial computed tomography (CCT) if the initial CCT scan showed no signs of ICB. Regarding treatment 3 studies elaborated therapeutic approaches for patients suffering from ICB under AC. There were 10 studies where it was reported that AC entails an increased risk of developing ICB whereas 4 studies claimed that AC has no impact on ICB evolving after TBI. Due to the fact that the evidence is not consistent regarding the management of TBI under AC a coherent and generally applicable recommendation does not exist. We recommend that a CCT scan should be performed within 30 min after admission for every patient suffering from TBI under AC. Furthermore, patients should be admitted for observation over 48 h for neurological surveillance. It remains controversial if a control CCT needs to be accomplished in patients without neurological deficits before discharge.     «

Traumatic brain injury (TBI) with concomitant anticoagulation (AC) is a common presentation in emergency departments, especially as the average age of the population is rising entailing an increasing number of co-morbidities requiring AC. Although minor head trauma (MHT) under AC is a common entity the literature remains controversial with regard to imaging and treatment. An evidence-based review of the risk of intracranial bleeding (ICB) in MHT under AC was carried out. A systemic analysis of t...     »