Mild brain injury and anticoagulants: Less is enough

Laura Campiglio; Francesca Bianchi; Claudio Cattalini; Daniela Belvedere; Chiara Emilia Rosci; Chiara Livia Casellato; Manuela Secchi; Maria Cristina Saetti; Elena Baratelli; Alessandro Innocenti; Ilaria Cova; Chiara Gambini; Luca Romano; Gaia Oggioni; Rossella Pagani; Marco Gardinali; Alberto Priori

doi:10.1212/CPJ.0000000000000375

Mild brain injury and anticoagulants: Less is enough

Laura Campiglio, Francesca Bianchi, Claudio Cattalini, Daniela Belvedere, Chiara Emilia Rosci, Chiara Livia Casellato, Manuela Secchi, Maria Cristina Saetti, Elena Baratelli, Alessandro Innocenti, Ilaria Cova, Chiara Gambini, Luca Romano, Gaia Oggioni, Rossella Pagani, Marco Gardinali, Alberto Priori

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Despite the higher theoretical risk of traumatic intracranial hemorrhage (ICH) in anticoagulated patients with mild head injury, the value of sequential head CT scans to identify bleeding remains controversial. This study evaluated the utility of 2 sequential CT scans at a 48-hour interval (CT1 and CT2) in patients with mild head trauma (Glasgow Coma Scale 13-15) taking oral anticoagulants. Methods: We retrospectively evaluated the clinical records of all patients on chronic anticoagulation treatment admitted to the emergency department for mild head injury. Results: A total of 344 patients were included, and 337 (97.9%) had a negative CT1. CT2 was performed on 284 of the 337 patients with a negative CT1 and was positive in 4 patients (1.4%), but none of the patients developed concomitant neurologic worsening or required neurosurgery. Conclusions: Systematic routine use of a second CT scan in mild head trauma in patients taking anticoagulants is expensive and clinically unnecessary.

Original language	English
Pages (from-to)	296-305
Number of pages	10
Journal	Neurology: Clinical Practice
Volume	7
Issue number	4
DOIs	https://doi.org/10.1212/CPJ.0000000000000375
Publication status	Published - Aug 1 2017

ASJC Scopus subject areas

Clinical Neurology

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Campiglio, L., Bianchi, F., Cattalini, C., Belvedere, D., Rosci, C. E., Casellato, C. L., Secchi, M., Saetti, M. C., Baratelli, E., Innocenti, A., Cova, I., Gambini, C., Romano, L., Oggioni, G., Pagani, R., Gardinali, M., & Priori, A. (2017). Mild brain injury and anticoagulants: Less is enough. Neurology: Clinical Practice, 7(4), 296-305. https://doi.org/10.1212/CPJ.0000000000000375

Mild brain injury and anticoagulants : Less is enough. / Campiglio, Laura; Bianchi, Francesca; Cattalini, Claudio; Belvedere, Daniela; Rosci, Chiara Emilia; Casellato, Chiara Livia; Secchi, Manuela; Saetti, Maria Cristina; Baratelli, Elena; Innocenti, Alessandro; Cova, Ilaria; Gambini, Chiara; Romano, Luca; Oggioni, Gaia; Pagani, Rossella; Gardinali, Marco; Priori, Alberto.

In: Neurology: Clinical Practice, Vol. 7, No. 4, 01.08.2017, p. 296-305.

Research output: Contribution to journal › Article › peer-review

Campiglio, L, Bianchi, F, Cattalini, C, Belvedere, D, Rosci, CE, Casellato, CL, Secchi, M, Saetti, MC, Baratelli, E, Innocenti, A, Cova, I, Gambini, C, Romano, L, Oggioni, G, Pagani, R, Gardinali, M & Priori, A 2017, 'Mild brain injury and anticoagulants: Less is enough', Neurology: Clinical Practice, vol. 7, no. 4, pp. 296-305. https://doi.org/10.1212/CPJ.0000000000000375

Campiglio, Laura ; Bianchi, Francesca ; Cattalini, Claudio ; Belvedere, Daniela ; Rosci, Chiara Emilia ; Casellato, Chiara Livia ; Secchi, Manuela ; Saetti, Maria Cristina ; Baratelli, Elena ; Innocenti, Alessandro ; Cova, Ilaria ; Gambini, Chiara ; Romano, Luca ; Oggioni, Gaia ; Pagani, Rossella ; Gardinali, Marco ; Priori, Alberto. / Mild brain injury and anticoagulants : Less is enough. In: Neurology: Clinical Practice. 2017 ; Vol. 7, No. 4. pp. 296-305.

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abstract = "Background: Despite the higher theoretical risk of traumatic intracranial hemorrhage (ICH) in anticoagulated patients with mild head injury, the value of sequential head CT scans to identify bleeding remains controversial. This study evaluated the utility of 2 sequential CT scans at a 48-hour interval (CT1 and CT2) in patients with mild head trauma (Glasgow Coma Scale 13-15) taking oral anticoagulants. Methods: We retrospectively evaluated the clinical records of all patients on chronic anticoagulation treatment admitted to the emergency department for mild head injury. Results: A total of 344 patients were included, and 337 (97.9%) had a negative CT1. CT2 was performed on 284 of the 337 patients with a negative CT1 and was positive in 4 patients (1.4%), but none of the patients developed concomitant neurologic worsening or required neurosurgery. Conclusions: Systematic routine use of a second CT scan in mild head trauma in patients taking anticoagulants is expensive and clinically unnecessary.",

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AU - Campiglio, Laura

AU - Bianchi, Francesca

AU - Cattalini, Claudio

AU - Belvedere, Daniela

AU - Rosci, Chiara Emilia

AU - Casellato, Chiara Livia

AU - Secchi, Manuela

AU - Saetti, Maria Cristina

AU - Baratelli, Elena

AU - Innocenti, Alessandro

AU - Cova, Ilaria

AU - Gambini, Chiara

AU - Romano, Luca

AU - Oggioni, Gaia

AU - Pagani, Rossella

AU - Gardinali, Marco

AU - Priori, Alberto

PY - 2017/8/1

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N2 - Background: Despite the higher theoretical risk of traumatic intracranial hemorrhage (ICH) in anticoagulated patients with mild head injury, the value of sequential head CT scans to identify bleeding remains controversial. This study evaluated the utility of 2 sequential CT scans at a 48-hour interval (CT1 and CT2) in patients with mild head trauma (Glasgow Coma Scale 13-15) taking oral anticoagulants. Methods: We retrospectively evaluated the clinical records of all patients on chronic anticoagulation treatment admitted to the emergency department for mild head injury. Results: A total of 344 patients were included, and 337 (97.9%) had a negative CT1. CT2 was performed on 284 of the 337 patients with a negative CT1 and was positive in 4 patients (1.4%), but none of the patients developed concomitant neurologic worsening or required neurosurgery. Conclusions: Systematic routine use of a second CT scan in mild head trauma in patients taking anticoagulants is expensive and clinically unnecessary.

AB - Background: Despite the higher theoretical risk of traumatic intracranial hemorrhage (ICH) in anticoagulated patients with mild head injury, the value of sequential head CT scans to identify bleeding remains controversial. This study evaluated the utility of 2 sequential CT scans at a 48-hour interval (CT1 and CT2) in patients with mild head trauma (Glasgow Coma Scale 13-15) taking oral anticoagulants. Methods: We retrospectively evaluated the clinical records of all patients on chronic anticoagulation treatment admitted to the emergency department for mild head injury. Results: A total of 344 patients were included, and 337 (97.9%) had a negative CT1. CT2 was performed on 284 of the 337 patients with a negative CT1 and was positive in 4 patients (1.4%), but none of the patients developed concomitant neurologic worsening or required neurosurgery. Conclusions: Systematic routine use of a second CT scan in mild head trauma in patients taking anticoagulants is expensive and clinically unnecessary.

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