Science & Technology

Popular anticoagulants can lead to cerebral hemorrhage and death after head trauma

The image on the left shows the first CT scan of the brains of both clopidogrel (Plavix) and aspirin patients who visited the emergency department with a head injury that did not show intracranial hemorrhage. The image on the right shows a head CT obtained 24 hours later, with large parenchymal hemorrhage in the right frontal / parietal lobe. The patient died shortly after the second examination. Credits: RSNA and Warren Chang, MD

According to a study published today, in a three-year study of more than 1,000 patients, adults taking older anticoagulants such as clopidogrel (Plavix) and warfarin (Kumadin) had a skull. We found that there was a significantly higher risk of delayed internal hemorrhage and death after head trauma. (November 30, 2021) At the annual meeting of the Radiological Society of North America (RSNA).Take aspirin at the same time Any Anticoagulants can increase the risk of delayed bleeding.

Intracranial hemorrhage occurs when blood vessels in the brain rupture and blood is released into the brain tissue. With delayed traumatic intracranial hemorrhage, cerebral hemorrhage occurs after the first trauma, usually within 48 hours after the first negative head CT.

High blood pressure, head trauma, and the use of anticoagulants are known causes of intracranial hemorrhage. As the population ages, the prevalence of patients taking anticoagulants is increasing.

“The incidence of delayed intracranial hemorrhage after trauma in patients using different types of anticoagulants, with or without aspirin, is not well established,” said a neuroradiologist. Said Dr. Warrenchan, MD, Head of Research at the Imaging Institute of the Allegheny Health Network. Pennsylvania. “This is an active area of ​​research, especially as new anticoagulants become more widely adopted.”

Adults taking anticoagulants suffering from head injuries usually have a CT scan of the brain. However, standard treatment beyond the initial image is not well defined. Some hospitals allow repeated patient observations and CT imaging, while others may discharge stable patients without intracranial hemorrhage.

“Different hospital networks have different strategies for repeatedly imaging these patients,” said Dr. Chan.

In a retrospective analysis, researchers were taking anticoagulants with head injuries and CT imaging on the Allegheny Health Network between January 1, 2017 and January 1, 2020. We reviewed the records of all patients. Intracranial hemorrhage was negative, followed by repeated imaging tests. The final study group of 1,046 patients included 547 females and 499 males with an average age of 77.5 years.

Within the study group, 576 patients took one of the new anticoagulants such as apixaban (Eliquis), rivaroxaban (Xarelto), and dabigatran (Pradaxa), and 470 patients received warfarin, clopidogrel, or another. I was taking old medicine.

Overall, the incidence of delayed bleeding was 1.91% (20 patients) and the mortality rate was 0.3% (3 patients). All deaths in the study group were among patients in the warfarin / clopidogrel / older anticoagulant group.

Within the entire study group, 345 patients were taking both anticoagulants and aspirin. Of the 20 patients with delayed bleeding, 15 were taking older types of anticoagulants, and 9 of 15 were also taking aspirin.

“Bleeding delay rates were higher in patients taking older anticoagulants compared to new drugs, and significantly higher in patients taking aspirin in addition to older drugs,” Dr. Chan said. ..

Of the five patients taking new anticoagulants who experienced delayed bleeding, four were also taking aspirin.

“Given the large number of trauma patients taking aspirin and anticoagulants, this study guides the care of patients with closed head injuries in emergency medicine and supports efforts to properly use imaging resources. “It helps,” said Thomas Campbell, MD, of the system. Chair of Emergency Medicine, Allegheny Health Network.

Based on the findings, the authors of the study found that patients who did not have the first intracranial hemorrhage due to a head injury taking one of the older anticoagulants, and taking anticoagulants with aspirin. Follow-up CT is recommended for patients with illness. Patients who take only one of the new anticoagulants and do not take aspirin do not need follow-up CT unless there are external signs of trauma.

“Taking an anticoagulant at the same time as aspirin significantly increased the risk of delayed bleeding, but taking one of the new drugs without aspirin significantly reduced the risk,” said Dr. Chan. I am.

“This study shows how innovative images can drive optimal patient care. In the end, I believe that recommendations for this work will save many lives,” said Allegheny Health Network. Bethany Casagranda, DO, chair of the Imaging Institute, said.

Additional co-authors include Michael P. Spearman, MD, Michael F. Goldberg, MD, Christian P. Wanamaker, MD, Ph.D., Charles Q. Li, MD, Laura Eisenmenger, MD, Albert Sohn, MD, Tyson Tragon. is. , MD, Matthew Kulzer, MD, Brian Weston, MD, and J. Danielle Yin, MD

Conference: The 107th Scientific Conference and Annual Conference of the Radiological Society of North America

Popular anticoagulants can lead to cerebral hemorrhage and death after head trauma Popular anticoagulants can lead to cerebral hemorrhage and death after head trauma

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