Determining the risk of development of cranial pathology in patients with minor head injury using antiagregan-anticoagulants

Yıl 2023, Cilt: 4 Sayı: 2, 102 - 112, 31.05.2023

Habibe Selmin ÖZENSOY Fikret BİLDİK Sema ÖZTÜRK Zeynep YAVUZ Alev Duygu SÜRE PİRHAN Ahmet DEMİRCAN Ayfer KELEŞ Isa KİLİCASLAN

Öz

Background: Patients use antiplatelet/anticoagulant drug which is increasing bleeding tendency is increasing with age. These patients can be admitted to the emergency room with minor head trauma and some ambiguities which may occur in the management of emergency services We undertook this study to determine the factor of intracranial hemorrhage in anticoagulated patients and patients on antiplatelet therapy and its impact on clinical management, identify predictors of positive imaging findings and their outcomes.
Methods: ın a prospective analysis, All patients who had minor head trauma between June 1, 2014 and May 1 2015 were included in this study. They should be evaluated by doctors in the ED; no interference will be made during diagnosis and treatment. We reviwed medications, mechanism of injury, head CT results and outcomes. Demografic data, symptoms, clinical examinations were recorded.
Results: 606 patients with minor head trauma were admitted to the emergency department. The average age of patients was 48.6 ± 22.6 and 57% (n = 345) were men, 43% (n = 261) were female. 30% of them (n:182) were taking antiplatelet/anticoagulant. Patients who use antiplatelet/anticoagulat is older then patients who didn’t use antiplatelet/anticoagulat therapy. Patients had CT scanned and they had 14,6% pathological finding. But this wasn’t statistically significant (p=0,762). Similarly, there was no statistically significant difference between 68 users antiplatelet and anticoagulant therapy (p = 0.865). Nausea was statistically significant in patients with pathology in the head CT (p=0,045).
Conclusion: Minor head trauma in patients may die or have brain hemorrhage who use ASA with klopidogrel. However, symptoms of the patient, physical examination and laboratory data are insufficient to predict the risk of intracranial pathology.

Anahtar Kelimeler

Keywords: Minor head trauma, antiplatelet/anticoagulant therapy, intracranial pathology

Kaynakça

• Bárcena A, Rodriguez-Arias C, Rivero Martin B, Canizal-GarciaJM, Mestre-Moreiro C, Calvo-Perez J, et al. Revisión deltraumatismo craneoencefálico. Neurocirugía.2006;17:495–518.
• Elizabeth Burns, Ramakrishna Kakara, Deaths from Falls Among Persons Aged ≥65 Years United States, 2007–2016 MMWR, May 11, 2018. Vol. 67, No. 18
• Zubair Shah at all Managing Antiplatelet Therapy and Anticoagulants in Patients with Coronary Artery Disease and Atrial Fibrillation Journal of Atrial Fibrillation. Oct-Nov 2015, Volume 8, Issue 3
• Mina AA, Knipfer JF, Park DY, Bair HA, Howells GA, Bendick PJ. Intracranial complications of preinjury anticoagulation in trauma patients with head injury. J Trauma. 2002;53(4):668-72.
• Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100-5.
• Franko J, Kish KJ, O'Connell BG, Subramanian S, Yuschak JV. Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma. J Trauma. 2006;61(1):107-10.
• Ivascu FA, Howells GA, Junn FS, Bair HA, Bendick PJ, Janczyk RJ. Predictors of mortality in trauma patients with intracranial hemorrhage on preinjury ASA or clopidogrel. J Trauma. 2008;65(4):785-8
• Marti G. Parker and Mats Thorslund Health Trends in the Elderly Population: Getting Better and Getting Worse the Gerontologist 2007 Vol 47, No. 2, 150–158
• Hoşgör Ş TA. 2050'ye Doğru Nüfusbilim ve Yönetim: Eğitim, İşgücü, Sağlık ve Sosyal Güvenlik Sistemlerine Yansımalar. İstanbul: TÜSİAD-T, 2010.
• Vos PE, Alekseenko Y, Battistin L, Ehler E, Gerstenbrand F, Muresanu DF, et al. Mild traumatic brain injury. Eur J Neurol. 2012;19(2):191-8.
• Llompart-Pou JA, Pérez-Bárcena J. Geriatric traumatic braininjury: An old challenge. Med Intensiva. 2019; 43:44—6, http://dx.doi.org/10.1016/j.medin.2018.02.009
• Puzio TJ, Murphy PB, Kregel HR, et al. Delayed intracranial hemorrhage after blunt head trauma while on direct oral anticoagulant: systematic review and meta-analysis. J Am Coll Surg 2021; 232:1007e1015
• Brewer ES, Reznikov B, Liberman RF, Baker RA, Rosenblatt MS, David CA, et al. Incidence and predictors of intracranial hemorrhage after minor head trauma in patients taking anticoagulant and antiplatelet medication. J Trauma. 2011;70(1): E1-5.
• Sharif-Alhoseini M, Khodadadi H, Chardoli M, Rahimi-Movaghar V. Indications for brain computed tomography scan after minor head injury. J Emerg Trauma Shock. 2011;4(4):472-6.
• Viola L, Zotta D, Martino V, Barbato R, Schisano G. Minor head injuries: one year experience according to the new Italian guideline. Acta Neurochir (Wien). 2000;142(11):1281-5.
• Alrajhi KN, Perry JJ, Forster AJ. Intracranial bleeds after minor and minimal head injury in patients on warfarin. J Emerg Med. 2015;48(2):137-42.
• Saboori M, Ahmadi J, Farajzadegan Z. Indications for brain CT scan in patients with minor head injury. Clin Neurol Neurosurg. 2007;109(5):399-405.
• Gomez PA, Lobato RD, Ortega JM, De La Cruz J. Mild head injury: differences in prognosis among patients with a Glasgow Coma Scale score of 13 to 15 and analysis of factors associated with abnormal CT findings. Br J Neurosurg. 1996;10(5):453-60.
• Servadei F, Teasdale G, Merry G, Neurotraumatology Committee of the World Federation of Neurosurgical S. Defining acute mild head injury in adults: a proposal based on prognostic factors, diagnosis, and management. J Neurotrauma. 2001;18(7):657-64.
• Gittleman AM, Ortiz AO, Keating DP, Katz DS. Indications for CT in patients receiving anticoagulation after head trauma. AJNR Am J Neuroradiol. 2005;26(3):603-6.
• Levine M, Wyler B, Lovecchio F, Roque P, Raja AS. Risk of intracranial injury after minor head trauma in patients with pre-injury use of clopidogrel. Am J Emerg Med. 2014;32(1):71-4.
• Miller EC, Derlet RW, Kinser D. Minor head trauma: Is computed tomography always necessary? Ann Emerg Med. 1996;27(3):290-4.
• Boran BO BN, Akgün C, Çelikoğlu E, Bozbuğa M. Hafif kafa travmalı olgularda bilgisayarlı beyin tomografisiendikasyonları. Ulusal Travma Acil Cerrahi Dergisi. 2005; 11:218-25.
• Ohm C, Mina A, Howells G, Bair H, Bendick P. Effects of antiplatelet agents on outcomes for elderly patients with traumatic intracranial hemorrhage. J Trauma. 2005;58(3):518-22.
• Falzon CM, Celenza A, Chen W, Lee G. Comparison of outcomes in patients with head trauma, taking preinjury antithrombotic agents. Emerg Med J. 2013;30(10):809-14.
• Menditto VG, Lucci M, Polonara S, Pomponio G, Gabrielli A. Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol. Ann Emerg Med. 2012;59(6):451-5.
• Karni A, Holtzman R, Bass T, Zorman G, Carter L, Rodriguez L, et al. Traumatic head injury in the anticoagulated elderly patient: a lethal combination. Am Surg. 2001;67(11):1098-100.
• Miller J, Lieberman L, Nahab B, Hurst G, Gardner-Gray J, Lewandowski A, et al. Delayed intracranial hemorrhage in the anticoagulated patient: A systematic review. J Trauma Acute Care Surg. 2015;79(2):310-3.
• Pozzessere A, Grotts J, Kaminski S. Dabigatran Use Does Not Increase Intracranial Hemorrhage in Traumatic Geriatric Falls When Compared with Warfarin. Am Surg. 2015;81(10):1039-42.
• Feild C, Tran BA, Johnson J. 1182: Trauma Patients Admitted Taking Warfarin or Dabigatran-a Comparison of Management and Outcomes. Crit Care Med. 2015;43(12 Suppl 1):297.
• Hart RG, Diener HC, Yang S, Connolly SJ, Wallentin L, Reilly PA, et al. Intracranial hemorrhage in atrial fibrillation patients during anticoagulation with warfarin or dabigatran: the RE-LY trial. Stroke. 2012;43(6):1511-7.
• Parra MW, Zucker L, Johnson ES, Gullett D, Avila C, Wichner ZA, et al. Dabigatran bleed risk with closed head injuries: are we prepared? J Neurosurg. 2013;119(3):760-5.
• Subcommittee A, American College of Surgeons' Committee on T, International Awg. Advanced trauma life support (ATLS(R)): The Ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363-6.
• RJ. T. A regulatory authority’s opinion about surrogate endpoints. In: Nimmo WS, Tucker GT, eds. Clinical measurement in drug evaluation. John Wiley & Sons. 1995:3-22.
• Fleming TR, DeMets DL. Surrogate end points in clinical trials: are we being misled? Ann Intern Med. 1996;125(7):605-13.
• Peck KA, Sise CB, Shackford SR, Sise MJ, Calvo RY, Sack DI, et al. Delayed intracranial hemorrhage after blunt trauma: are patients on preinjury anticoagulants and prescription antiplatelet agents at risk? J Trauma. 2011;71(6):1600-4.