Do We Need to Repeat the Initially Normal Head Computerized Tomography for Patients with Mild Head Trauma Using Anticoagulant and/or Antiplatelet Therapy?

Abstract

Objective: Patients using anticoagulant and/or antiplatelet (AC/AP) medications are at an increased risk of intracranial hemorrhage (ICH) subsequent to head trauma and current guidelines recommend a head computed tomography (CT) scan for these patients. There is a lack of consensus about management recommendations for mild head trauma patients on AC/AP treatment who had an initially normal head CT. The aim of this study was to determine the rate of delayed ICH after a 24-hour observation in patients with mild head trauma using AC/AP who had an initially normal head CT. Method: Patients aged 18 and older, using AC/AP drugs with mild head trauma were included prospectively. Patients underwent head CT for suspected bleeding. A repeat CT scan was performed after a 24-hours observation period for the patients who had an initially normal head CT for detecting delayed intracranial hemorrhage. Result: A total of 101 patients were included and, 57.4% (n=58) of the patients were female. Delayed ICH was detected in 2.9% (n=3) of the patients after a 24-hour observation. None of the patients with delayed ICH needed surgical treatment or further intervention. Delayed ICH was found in patients who used acetylsalicylic acid (n=1), dabigatran (n=1), and apixaban (n=1). Conclusion: In patients with mild head trauma using AC/AP, delayed intracranial hemorrhage is rare and may be clinically insignificant. A repeat CT scanning after 24-hour observation may not be necessary for patients with mild head trauma using AC/AP therapy who had initially normal head CT.

Keywords

• Anticoagulant drugs
• antiplatelet drugs
• head trauma
• intracranial hemorrhage

Antikoagülan ve/veya Antiplatelet Tedavi Kullanan Hafif Kafa Travmalı Hastalarda Başlangıçta Normal olan Bilgisayarlı Kafa Tomografisini Tekrarlamamız Gerekir mi?

Abstract

Amaç: Antikoagülan ve/veya antiplatelet (AC/AP) ilaç kullanan hastalarda kafa travması sonrası intrakraniyal kanama (İKK) riski yüksektir ve güncel kılavuzlar bu hastalar için bilgisayarlı kafa tomografisi (BT) görüntülemesini önermektedir. Başlangıçta normal kafa BT'si olan ve AC/AP ilaçları kullanan hafif kafa travmalı hastalar için yönetim önerileri konusunda fikir birliği yoktur. Bu çalışmanın amacı, başlangıçta normal kafa BT'si olan ve AC/AP kullanan hafif kafa travmalı hastalarda 24 saatlik bir gözlem sonrasında gecikmiş İKK oranını belirlemektir. Metod: AC/AP ilaç kullanan, 18 yaş ve üzeri hafif kafa travmalı hastalar prospektif olarak çalışmaya alındı. Hastalara kanama şüphesi nedeniyle kafa BT’si çekildi. Çekilen ilk kafa BT'si normal olan hastalara gecikmiş intrakraniyal kanamayı saptamak için 24 saatlik gözlem süresi sonrasında tekrar kafa BT görüntülemesi yapıldı. Bulgular: Toplam 101 hasta çalışmaya dahil edildi ve hastaların %57,4'ü (n=58) kadındı. 24 saatlik gözlem sonrasında hastaların %2,9'unda (n=3) gecikmiş İKK saptandı. Gecikmiş İKK'li hastaların hiçbirinde cerrahi tedavi veya başka girişim gerekmedi. Gecikmiş İKK, asetilsalisilik asit (n=1), dabigatran (n=1) ve apiksaban (n=1) kullanan hastalarda saptandı. Sonuç: AC/AP kullanan hafif kafa travmalı hastalarda gecikmiş İKK nadirdir ve klinik olarak önemli olmayabilir. Başlangıçta kafa BT'si normal olan, AC/AP ilaç kullanan hafif kafa travması olan hastalarda 24 saatlik gözlemden sonra kafa BT görüntülemesinin tekrarı gerekli olmayabilir.

Keywords

• Antikoagülan ilaçlar
• antiplatelet ilaçlar
• kafa travması
• intrakraniyal kanama

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