Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · TBI General

To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin

There´s a paucity of guidelines and recommendations on diagnostic pathways in patients on warfarin who sustain head injuries. This article by Alrajhi et al from 2015 (J Emerg Med) looked at an historical cohort of patients on warfarin admitted for either minor (Glasgow Coma Score 13-15, with loss of consciousness, amnesia, or confusion) or minimal (Glasgow Coma Score 15 without loss of consciousness, amnesia, or confusion) head injuries. They included 176 patients of whom the vast majority underwent a CT scan. As many as 21.9% and 4.8%, respectively in the minor and minimal head injury cohorts, had intracranial bleeding.

In this material IC bleeds was a surprisingly common occurrence even in patients with relatively mild clinical signs. This should lead all clinicians to have a low threshold for ordering scans in this patient group.

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