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Anticoagulation head injury

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https://www.readbyqxmd.com/read/30097750/blunt-traumatic-vascular-injuries-of-the-head-and-neck-in-the-ed
#1
Elizabeth George, Ashish Khandelwal, Christopher Potter, Aaron Sodickson, Srinivasan Mukundan, Diego Nunez, Bharti Khurana
Cerebrovascular injury is increasingly identified in patients presenting after blunt trauma due to the implementation of screening criteria and advances in noninvasive angiographic imaging by CT. The variable latent time before onset of secondary stroke presents a window of opportunity for prevention, reinforcing the importance of detection of asymptomatic patients via screening. Furthermore, the high morbidity and mortality associated with secondary stroke makes it imperative that radiologists recognize these challenging injuries...
August 10, 2018: Emergency Radiology
https://www.readbyqxmd.com/read/30078628/worsening-head-bleeds-in-elderly-blunt-head-trauma-patients-taking-antithrombotics-delayed-ct-head-fails-to-change-management
#2
Dane Scantling, Robert Kucejko, John Williamson, Alvaro Galvez, Amanda Teichman, Ryan Gruner, Nicholas Serniak, Brendan McCracken
BACKGROUND: Most elderly trauma patients suffer blunt head injury and many utilize antithrombotic (AT) medications. The utility of delayed CT-head (D-CTH) in neurologically intact elderly patients using AT who have an intracranial hemorrhage (ICH) on presentation is unknown. We hypothesized that D-CTH would not alter clinical management and aimed to evaluate the role of D-CTH in this population. METHODS: A retrospective cohort study was performed. Patients ≥65 years sustaining blunt head injuries from January 2010 to July 2017 were identified using our level 1 trauma center database...
July 29, 2018: Injury
https://www.readbyqxmd.com/read/30065073/understanding-the-management-of-patients-with-head-injury-taking-warfarin-who-should-we-scan-and-when-lessons-from-the-ahead-study
#3
Suzanne M Mason, Rachel Evans, Maxine Kuczawski
Anticoagulated patients represent an important and increasing proportion of the patients with head trauma attending the ED, but there is no international consensus for their appropriate investigation and management. International guidelines vary and are largely based on a small number of studies, which provide poor-quality evidence for the management of patients taking warfarin. This article provides an overview of the clinical research evidence for CT scanning head-injured patients taking warfarin and a discussion of interpretation of risk and acceptable risk...
July 31, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/30064584/does-antithrombotic-drug-use-mandate-trauma-team-activation-in-awake-geriatric-patients-with-intracranial-hemorrhage
#4
Jeffrey A Moyer, Jharna Shah, Kevin Nowakowski, Anthony Martin, Amanda McNicholas, Alison Muller, Forrest B Fernandez, Adrian W Ong
Antithrombotic (anticoagulant [AC] and antiplatelet [AP]) drugs have been associated with mortality in geriatric patients with intracranial hemorrhage (ICH). It is unclear whether trauma team activation (TTA) in this cohort impacts outcome. Patients ≥65 years with a Glasgow Coma Scale of ≥13 and ICH over four years were included and were divided into three groups according to type of drug: group 1, AC with or without AP; group 2, AP only and; group 3, no AC or AP. The Rotterdam score was used to characterize the severity of CT findings...
July 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/30028001/incidence-of-intracranial-bleeding-in-anticoagulated-patients-with-minor-head-injury-a-systematic-review-and-meta-analysis-of-prospective-studies
#5
Hersimren Minhas, Arthur Welsher, Michelle Turcotte, Michelle Eventov, Suzanne Mason, Daniel K Nishijima, Grégoire Versmée, Meirui Li, Kerstin de Wit
Guidelines advise performing a computed tomography head scan for all anticoagulated head injured patients, but the risk of intracranial haemorrhage (ICH) after a minor head injury is unclear. We conducted a systematic review and meta-analysis to determine the incidence of ICH in anticoagulated patients presenting with a minor head injury and a Glasgow Coma Score (GCS) of 15. We followed Meta-Analyses and Systematic Reviews of Observational Studies guidelines. We included all prospective studies recruiting consecutive anticoagulated emergency patients presenting with a head injury...
July 20, 2018: British Journal of Haematology
https://www.readbyqxmd.com/read/29959076/development-of-a-delayed-posttraumatic-acute-subdural-hematoma
#6
Ilya Rybkin, Michael Kim, Anubhav Amin, Michael Tobias
BACKGROUND: Prior studies have shown that most patients with mild traumatic brain injury (TBI) or negative computed tomography (CT) scans of the head rarely decline or require neurosurgical interventions. One common reason for a delayed decline is an intracranial hemorrhage which presents within 24 to 48 hours. This is typically seen in elderly patients and/or patients on antiplatelet or anticoagulation agents. We describe a case of a delayed subdural hemorrhage presenting in a young adult not on any antiplatelet or anticoagulation therapy...
June 26, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29937636/utility-of-abdominal-computed-tomography-in-geriatric-patients-on-warfarin-with-a-fall-from-standing
#7
Amit Bahl, Steven Schafer
Context: Geriatric head trauma resulting from falls has been extensively studied both in the presence and absence of blood thinners. In this population, however, the prevalence and extent of abdominal injury resulting from falls are much less defined. Aim: We aim to evaluate the utility of abdominal computed tomography (CT) imaging in geriatric patients on Warfarin with a recent history of fall. Setting and Design: A retrospective analysis was completed of consecutive geriatric patients who presented to a Level 1 Trauma Center emergency department after fall from standing while taking Warfarin...
April 2018: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/29895339/a-systematic-review-of-the-risks-and-benefits-of-venous-thromboembolism-prophylaxis-in-traumatic-brain-injury
#8
Joseph Margolick, Charlotte Dandurand, Katrina Duncan, Wenjia Chen, David C Evans, Mypinder S Sekhon, Naisan Garraway, Donald E G Griesdale, Peter Gooderham, S Morad Hameed
BACKGROUND: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of pharmacological venous thromboprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the postinjury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. METHODS: MEDLINE and EMBASE databases were searched. Inclusion criteria were studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation...
July 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/29858414/incidence-course-and-risk-factors-of-head-injury-a-retrospective-cohort-study
#9
Herman Gerritsen, Mariam Samim, Hans Peters, Henk Schers, Floris A van de Laar
OBJECTIVES: To assess the incidence of head injury and predictors of complication across the care continuum. DESIGN: Retrospective cohort study using data from a research network. We calculated the incidence of overall head injury in a longitudinal cohort covering 1-year interval (31 369 patient-years), and the incidence of complicated head injury in a longitudinal cohort covering 10 years interval (220 352 patient-ears). Incidence rates were calculated per 1000 patient-years with 95% CI using the Mid-P exact test...
May 31, 2018: BMJ Open
https://www.readbyqxmd.com/read/29851905/the-novel-oral-anticoagulants-noacs-have-worse-outcomes-compared-to-warfarin-in-patients-with-intracranial-hemorrhage-after-tbi
#10
Muhammad Zeeshan, Faisal Jehan, Terence O'Keeffe, Muhammad Khan, El Rasheid Zakaria, Mohammad Hamidi, Lynn Gries, Narong Kulvatunyou, Bellal Joseph
INTRODUCTION: Novel-oral-anticoagulants(NOACs) use is increasing in trauma patients. The reversal of these agents after hemorrhage is still evolving. The aim of our study was to evaluate outcomes after traumatic brain injury in patients on NOACs. METHODS: 3-year (2014-2016) analysis of our prospectively maintained TBI database. We included all TBI patients with intracranial-hemorrhage (ICH) on anticoagulants. Patients were stratified into two groups; those on NOACs and on Warfarin, and were matched in a 1:2 ratio using propensity score matching for demographics, injury and vital parameters, type, and size of ICH...
May 30, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29550926/management-of-mild-traumatic-brain-injury-trauma-energy-level-and-medical-history-as-possible-predictors-for-intracranial-hemorrhage
#11
Tomas Vedin, Sebastian Svensson, Marcus Edelhamre, Mathias Karlsson, Mikael Bergenheim, Per-Anders Larsson
PURPOSE: Head trauma is common in the emergency department. Identifying the few patients with serious injuries is time consuming and leads to many computerized tomographies (CTs). Reducing the number of CTs would reduce cost and radiation. The aim of this study was to evaluate the characteristics of adults with head trauma over a 1-year period to identify clinical features predicting intracranial hemorrhage. METHODS: Medical record data have been collected retrospectively in adult patients with traumatic brain injury...
March 17, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29541804/evaluation-of-a-protocol-for-early-detection-of-delayed-brain-hemorrhage-in-head-injured-patients-on-warfarin
#12
Jing Li Huang, Theo A Woehrle, Pat Conway, Catherine A McCarty, Madeline M Eyer, Steven D Eyer
PURPOSE: In 2007, Essentia Health St. Mary's Medical Center (SMMC), a Level II trauma center in northeastern Minnesota, implemented a protocol for patients who presented with blunt head trauma and were receiving warfarin for anticoagulation. The purpose of this study was to determine the incidence and risk factors of early delayed, warfarin-associated intracranial hemorrhage (ICH). METHODS: Adult patients with signs and symptoms of head injury on warfarin who were admitted by protocol to SMMC between March 2007 and June 2015 were included...
March 14, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29521777/heads-up-describing-and-implementing-a-time-saving-head-strike-protocol-at-a-level-ii-trauma-center
#13
Sharon Wacht, Kristin Salottolo, Amy Atnip, Michelle Hooks, Mary Bailie, Matthew Carrick
Head strikes can be fatal for patients taking blood thinners (anticoagulants or antiplatelets). Our trauma center instituted the "head strike protocol" to provide uniform and expedited care for adult trauma patients taking preinjury anticoagulants and antiplatelet medications with suspected head injury. The purpose of this article is to describe the development and implementation of the head strike protocol and compare time metrics and outcomes before and after implementing the protocol. Per the head strike protocol, patients with suspected traumatic intracranial hemorrhage (tICH) were screened for anticoagulants or antiplatelet medications by emergency medical service personnel/at first contact, activated as a Level II trauma and received a computed tomographic scan of the head within 30 min of arrival, and started reversal of blood products within 30 min of tICH confirmation...
March 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29496726/utility-of-repeat-head-ct-in-patients-with-blunt-traumatic-brain-injury-presenting-with-small-isolated-falcine-or-tentorial-subdural-hematomas
#14
K K Devulapalli, J F Talbott, J Narvid, A Gean, B Rehani, G Manley, A Uzelac, E Yuh, M C Huang
BACKGROUND AND PURPOSE: In blunt traumatic brain injury with isolated falcotentorial subdural hematoma not amenable to neurosurgical intervention, the routinely performed, nonvalidated practice of serial head CT scans frequently necessitates increased hospital resources and exposure to ionizing radiation. The study goal was to evaluate clinical and imaging features of isolated falcotentorial subdural hematoma at presentation and short-term follow-up. MATERIALS AND METHODS: We performed a retrospective analysis of patients presenting to a level 1 trauma center from January 2013 to March 2015 undergoing initial and short-term follow-up CT with initial findings positive for isolated subdural hematoma along the falx and/or tentorium...
April 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29492322/chronic-subdural-hematoma-of-the-posterior-fossa-treated-by-suboccipital-craniotomy
#15
Yuichi Mochizuki, Tomonori Kobayashi, Akitsugu Kawashima, Takayuki Funatsu, Takakazu Kawamata
Background: Chronic subdural hematoma (CSDH) of the posterior fossa is uncommon in adults. Only a few cases have been reported, and most of these were secondary to head injury or anticoagulant therapy. We herein describe a case of successful surgical treatment of CSDH in the posterior fossa after surgical removal of a large supratentorial and infratentorial dermoid cyst. Case Description: A 71-year-old woman underwent removal of a left supratentorial and infratentorial dermoid cyst via a left transzygomatic approach...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/29452965/reversal-of-antiplatelet-therapy-in-traumatic-intracranial-hemorrhage-does-timing-matter
#16
Urmil Pandya, Alexander Malik, Michael Messina, Abdul-Rahman Albeiruti, Chance Spalding
Reversal of antiplatelet therapy with platelet transfusion in traumatic intracranial hemorrhage remains controversial. Several studies have examined this topic but few have investigated whether the timing of transfusion affects outcomes. Patients admitted to a level 1 trauma center from 1/1/14 to 3/31/16 with traumatic intracranial hemorrhage taking pre-injury antiplatelet therapy were retrospectively analyzed. Patients on concurrent pre-injury anticoagulant therapy were excluded. Per institutional guideline, patients on pre-injury clopidogrel received 2 doses of platelets while patients on pre-injury aspirin received 1 dose of platelets...
April 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29450470/incidence-of-delayed-intracranial-hemorrhage-in-older-patients-after-blunt-head-trauma
#17
James A Chenoweth, Samuel D Gaona, Mark Faul, James F Holmes, Daniel K Nishijima
Importance: Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not. Objective: To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications. Design, Setting, and Participants: This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016...
June 1, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29433872/activated-prothrombin-complex-concentrate-for-warfarin-reversal-in-traumatic-intracranial-hemorrhage
#18
Chancey Carothers, Amanda Giancarelli, Joseph Ibrahim, Brandon Hobbs
BACKGROUND: Patients with traumatic intracranial hemorrhage (TIH) anticoagulated with warfarin are at an increased risk of mortality. Fresh frozen plasma (FFP) and vitamin K have been the standard treatment for warfarin reversal; however, guidelines now recommend the use of prothrombin complex concentrate (PCC) for warfarin reversal in patients with life-threatening bleeding. Our protocol uses one vial (∼1000 units) of activated PCC (aPCC) for warfarin reversal, regardless of the weight or presenting international normalized ratio (INR)...
March 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29389749/trauma-and-transfusion-in-the-geriatric-patient
#19
Corey S Scher
PURPOSE OF REVIEW: The percentage of people over the age of 65 is growing rapidly and anesthesiologists must develop a medical understanding that is comprehensive to meet the unique medical needs of this population. The changing physiology of an elderly population makes them extremely vulnerable to trauma and the administration of blood products. Although most of these cases involve orthopedic attention, it is not less dangerous as a blunt trauma case. RECENT FINDINGS: This article addresses some of the main concerns for the anesthesiologists of providing a hemostatic resuscitation in the geriatric population...
April 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29303442/blossoming-contusions-identifying-factors-contributing-to-the-expansion-of-traumatic-intracerebral-hemorrhage
#20
Joseph A Carnevale, David J Segar, Andrew Y Powers, Meghal Shah, Cody Doberstein, Benjamin Drapcho, John F Morrison, John R Williams, Scott Collins, Kristina Monteiro, Wael F Asaad
OBJECTIVE Traumatic brain injury (TBI) remains a significant cause of neurological morbidity and mortality. Each year, more than 1.7 million patients present to the emergency department with TBI. The goal of this study was to evaluate the prognosis of traumatic cerebral intraparenchymal hemorrhage (tIPH), to develop subclassifications of these injuries that relate to prognosis, and to provide a more comprehensive assessment of hemorrhagic progression contusion (HPC) by analyzing the rate at which tIPH "blossom" (i...
January 5, 2018: Journal of Neurosurgery
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