Anticoagulation head injury

BACKGROUND: Antiplatelet and anticoagulant medication are increasingly common and can increase the risks of morbidity and mortality in traumatic brain injury (TBI) patients. Our study aimed to quantify the association of antiplatelet or anticoagulant use in intensive care unit (ICU)-treated TBI patients with 1-year mortality and head CT findings. METHOD: We conducted a retrospective, multicenter observational study using the Finnish Intensive Care Consortium database...

OBJECTIVE: Most older adults with traumatic brain injuries (TBI) reach the emergency department via the ambulance service. Older adults, often with mild TBI symptoms, risk being under-triaged and facing poor outcomes. This study aimed to identify whether sufficient information is available on the scene to an ambulance clinician to identify an older adult at risk of an intracranial haemorrhage following a head injury. METHODS: This was a retrospective case-control observational study involving one regional ambulance service in the UK and eight emergency departments...

INTRODUCTION: The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment. METHOD: We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with ≥1 risk factor at admission and at 24 h in those with neurological impairment or initial pathological cranial CT...

Introduction: Irregular bone defects of the humerus are common in clinical practice, but there are fewer reported cases of irregular humeral defects accompanied by shoulder joint "locking" dislocation and reverse Hill-Sachs injury caused by an electric shock. The choice of treatment for such cases is closely related to the extent of shoulder joint function recovery. This is a case report of a 60-year-old male patient who suffered from a shoulder joint "locking" dislocation with accompanying reverse Hill-Sachs injury due to muscle contraction after being electrically shocked at work...

INTRODUCTION: The Brain Injury Guidelines (BIG) stratify patients by traumatic brain injury (TBI) severity to provide management recommendations to reduce healthcare resource burden but mandates patients on anticoagulation (AC) are allocated to the most severe tertile (BIG 3). We sought to analyze TBI patients on AC therapy utilizing a modified BIG model to determine if this population can offer further opportunity for safe reductions in health care resource utilization. METHODS: Patients >55 years of age on AC with traumatic intracranial hemorrhage (ICH) from two centers were retrospectively stratified into BIG 1-3 risk groups using modified BIG criteria excluding AC as a criterion...

Stroke in children is more common than is often realised; there are numerous potential causes, including carotid artery injury resulting from minor head or neck trauma, as well as genetic conditions associated with thrombophilia. A 13-year-old boy suffered an arterial ischaemic stroke (AIS) secondary to dissection of the left internal carotid artery (ICA) after he headed the ball during a game of football. He presented with generalised tonic-clonic seizure, loss of consciousness, right-sided hemiplegia and aphasia...

PURPOSE: In general, risk of mortality after trauma correlates with injury severity. Despite arriving in relatively stable clinical condition, however, some patients are at risk of death following mild traumatic brain injury (TBI). The study objective was delineation of patients who die in-hospital following mild isolated TBI in order to inform Emergency Department (ED) disposition and care discussions with patients and families. METHODS: In this retrospective cohort study, patients from the National Trauma Data Bank (NTDB) (2007-2018) were included if they were injured by blunt trauma and sustained a mild TBI (defined as Head Abbreviated Injury Scale [AIS] score of 1 or 2 and arrival Glasgow Coma Scale [GCS] score of 13-15)...

BACKGROUND: Nomograms are easy-to-handle clinical tools which can help in estimating the risk of adverse outcome in certain population. This multi-center study aims to create and validate a simple and usable clinical prediction nomogram for individual risk of post-traumatic Intracranial Hemorrhage (ICH) after Mild Traumatic Brain Injury (MTBI) in patients treated with Direct Oral Anticoagulants (DOACs). METHODS: From January 1, 2016 to December 31, 2019, all patients on DOACs evaluated for an MTBI in five Italian Emergency Departments were enrolled...

BACKGROUND: Although clinical decision rules exist for patients with head injuries, no tool assesses patients with unknown trauma events. Patients with uncertain trauma may have unnecessary brain imaging. OBJECTIVE: This study evaluated risk factors and outcomes of geriatric patients with uncertain head injury. METHODS: This prospective cohort study included geriatric patients with definite or uncertain head injury presenting to two emergency departments (EDs)...

BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV ECMO) can support trauma patients with severe respiratory failure. Use in traumatic brain injury (TBI) may raise concerns of worsening complications from intracranial bleeding. However, VV ECMO can rapidly correct hypoxemia and hypercarbia, possibly preventing secondary brain injury. We hypothesize that adult trauma patients with TBI on VV ECMO have comparable survival to trauma patients without TBI. METHODS: Single center, retrospective cohort study involving review of electronic medical records of trauma admissions between July 1, 2014 to August 30, 2022 with discharge diagnosis of TBI who were placed on VV ECMO during their hospital course...

BACKGROUND: Anticoagulants prevent thrombosis in patients with atrial fibrillation (AF) and venous thromboembolism but increase the risk of hemorrhagic complications. If severe bleeding occurs with anticoagulant use, discontinuation and rapid reversal are essential. However, the optimal timing for resuming anticoagulants after using reversal agents remains unclear. Here, we report early cerebral infarction following the use of andexanet alfa (AA), a specific reversal agent for factor Xa inhibitors, in a patient with traumatic acute subdural hematoma (ASDH)...

BACKGROUND: Traumatic brain injury causes morbidity, mortality, and at least 2,500,000 yearly emergency department visits in the USA. Computerized tomography of the head is the gold standard to detect traumatic intracranial hemorrhage. Some are not diagnosed at the first scan, and they are denoted "delayed intracranial hemorrhages. " To detect these delayed hemorrhages, current guidelines for head trauma recommend observation and/or rescanning for patients on anticoagulation therapy but not for patients on antiplatelet therapy...

We present the case of a 59-year-old male who sustained an ascending aortic injury and a subdural hematoma after a head on collision. After undergoing emergent craniotomy for evacuation of the subdural hematoma, he was maintained with strict blood pressure control. Once able to be safely anticoagulated, he underwent replacement of the ascending aorta. This exceedingly rare case was managed by a multidisciplinary team approach that led to an optimal outcome given his disastrous multi-traumatic injuries.

BACKGROUND AND AIM: The aim of the study was to determine the impact of prior anticoagulant treatment on the characteristics of intracranial hematomas. METHODS: We included in this retrospective study 135 patients who were diagnosed with subdural hematoma in the context of traumatic brain injury. We recorded the demographic and clinical data, the paraclinical examinations and the characteristics of subdural hematoma evidenced by preoperative computed tomography (CT)...

Cerebral sinus vein thrombosis (CVT) is a relatively rare neurovascular entity, usually associated with acquired or genetic hypercoagulable states, and in many cases it remains idiopathic. Trauma is also associated with CVT among patients with major head or neck trauma, including penetrating injuries. However, CVT associated with acceleration trauma has only been described in few cases so far. We present an unusual case of a 19-year-old woman with no past medical history, admitted with an extensive CVT following sneezing...

BACKGROUND: Sudden loss of consciousness as a result of cardiac arrest can cause severe traumatic head injury. Collapse-related traumatic intracranial hemorrhage (CRTIH) following out-of-hospital cardiac arrest (OHCA) may be linked to poor neurological outcomes; however, there is a paucity of data on this entity. This study aimed to investigate the frequency, characteristics, and outcomes of CRTIH following OHCA. METHODS: Adult patients treated post-OHCA at 5 intensive care units who had head computed tomography (CT) scans were included in the study...

BACKGROUND: The optimal strategy for diagnosis and antithrombotic treatment of patients with antiphospholipid syndrome (APS)-associated acute ischemic stroke (AIS), transient ischemic attack (TIA), or other brain ischemic injury is poorly defined. OBJECTIVES: The survey goal was to capture variations in diagnosis and antithrombotic treatment of APS-associated ischemic stroke and related disorders to inform guidance and clinical trials to define optimal management...

PURPOSE: Chronic subdural haematoma (CSDH) is a well-recognized consequence of head injury with a rising incidence worldwide. Whilst symptomatic CSDH warrants consideration of surgical intervention, the management of asymptomatic CSDH (AsCSDH) remains unclear. In this retrospective study, we investigate the natural history of AsCSDH, the requirement for radiological monitoring, and the role of neurosurgical input. METHODS: Head injury referrals to a tertiary neurosurgical unit over two years were screened to identify patients with AsCSDH...

INTRODUCTION: Patients with cirrhosis have an increased risk of complications after trauma, including bleeding, unplanned operations, and death. The benefit of venous thromboembolism (VTE) chemoprophylaxis in trauma patients with cirrhosis (CTPs) is not clear, especially since cirrhotic patients are hypercoagulable. We hypothesized that CTPs receiving VTE chemoprophylaxis (vCP) have a lower risk of death with no increased risk for unplanned operations compared to patients with cirrhosis not receiving vCP...

BACKGROUND: Bleeding is a feared complication of antiplatelets (APTs) and oral anti-coagulants (OACs) use. Asians are at higher risk of bleeding from APT/OAC compared to Western population. Our study aims to investigate the impact of preinjury APT/OAC use on outcomes of moderate to severe blunt trauma. METHODS: This is a retrospective cohort study from Jan 2017 - Dec 2019 of all patients with moderate to severe blunt trauma. A 1:2 propensity score matching (PSM) analysis was performed to address for confounding factors...