• Clifford Swap, Margo Sidell, Raquel Ogaz, and Adam Sharp.
• Emergency Physician at the San Diego Medical Center in CA. clifford.j.swap@kp.org.
• Perm J. 2016 Jan 1; 20 (2): 14-6.

ContextPatients receiving anticoagulant medications who experience minor head injury are at increased risk of an intracerebral hemorrhage (ICH) developing, even after an initial computed tomography (CT) scan of the brain yields normal findings. Conflicting evidence exists regarding the frequency at which delayed bleeding occurs.ObjectiveTo identify the frequency of delayed traumatic ICH in patients receiving warfarin or clopidogrel.DesignWe performed a retrospective observational study of adult trauma encounters for anticoagulated patients undergoing head CT at 1 of 13 Kaiser Permanente Southern California Emergency Departments (EDs) between 2007 and 2011. Encounters were identified using structured data from electronic health and administrative records, and then records were individually reviewed for validation of results.Main Outcome MeasuresThe primary outcome measure was ICH within 60 days of an ED visit with a normal head CT result.ResultsOur sample included 443 (260 clopidogrel and 183 warfarin) eligible ED encounters with normal findings of initial head CT. Overall, 11 patients (2.5%, 95% confidence interval [CI] = 1.4%-4.4%) had a delayed ICH, and events occurred at similar rates between the clopidogrel group (6/260, 2.3%, CI 1.1%-5.0%) and warfarin group (5/183, 2.7%, CI 1.2%-6.2%).ConclusionTrauma patients in the ED who are receiving warfarin or clopidogrel have approximately a 2.5% risk of delayed ICH after an initial normal finding on a head CT.

19 keywords...

hide…