Podcast 746: Elderly Head Trauma on Anticoagulation

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Biggest study to date examined new protocol for repeat head CT in anticoagulated elderly patients with head trauma and an initial negative head CT</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">0.5%-6% of patients in this category will get a delayed ICH and this can occur up to a week out from initial injury</span></li> </ul> </li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">18% of the study group had an ICH on initial head CT, but the rest who had negative head CT initially received a repeat head CT at 6 hours</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">0.9% had a bleed identified on repeat head CT 6 hours after initial imaging, but of this group no one had an intervention for this bleed</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Suggests repeat head CT may not be needed and that good counseling for return precautions and discharge is a reasonable disposition in caring for these patients</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Supratherapeutic INR was a risk factor for delayed bleed, so they should be treated as a higher risk group of patients</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Borst J, Godat LN, Berndtson AE, Kobayashi L, Doucet JJ, Costantini TW. Repeat head computed tomography for anticoagulated patients with an initial negative scan is not cost-effective. Surgery. 2021;170(2):623-627. doi:10.1016/j.surg.2021.02.024</span></p> <p><em><span style="font-weight: 400;">Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD</span></em></p> <p> </p> <p><span style="font-weight: 400;">The Emergency Medical Min