Leichtes Schädel-Hirn-Trauma unter Antikoagulation. Erhöhtes Risiko für intrakranielle Blutung?

Translated title of the contribution: Mild traumatic brain injury with anticoagulation. Is there an increased risk for intracranial hemorrhaging?

S. A. Günther, J. Stegmaier, A. O. Paul, P. Biberthaler, W. Mutschler, K. G. Kanz

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Context. Traumatic brain injury (TBI) with concomitant anticoagulation (AC) is a com mon presentation in emergency depart ments, especially as the average age of the population is rising entailing an increasing number of co-morbidities requiring AC. Al though minor head trauma (MHT) under AC is a common entity the literature remains controversial with regard to imaging and treatment.Objective. An evidence-based review of the risk of intracranial bleeding (ICB) in MHT un der AC was carried out.Methods. A systemic analysis of the current literature from 1992 to 2010 listed in Pubmed and Medline was performed using the key words "minimal, minor or mild traumat ic brain injury" in combination with "aspirin, clopidogrel, coumadin, warfarin or coagulop athy". Exclusion criteria comprised spontane ous, non-traumatic ICB and studies including less than 50 patients.Results. A total of 18 studies met the inclu sion criteria and revealed that elderly pa tients under AC suffer more frequently from mild head trauma due to falls. Of these 2 pro spective studies dealt with the question of a control cranial computed tomography (CCT) if the initial CCT scan showed no signs of ICB. Regarding treatment 3 studies elaborated therapeutic approaches for patients suffer ing from ICB under AC. There were 10 stud ies where it was reported that AC entails an increased risk of developing ICB whereas 4 studies claimed that AC has no impact on ICB evolving after TBI.Conclusions. Due to the fact that the evi dence is not consistent regarding the man agement of TBI under AC a coherent and gen erally applicable recommendation does not exist. We recommend that a CCT scan should be performed within 30 min after admis sion for every patient suffering from TBI un der AC. Furthermore, patients should be ad mitted for observation over 48 h for neuro logical surveillance. It remains controversial if a control CCT needs to be accomplished in patients without neurological deficits before discharge.

Translated title of the contributionMild traumatic brain injury with anticoagulation. Is there an increased risk for intracranial hemorrhaging?
Original languageGerman
Pages (from-to)268-274
Number of pages7
JournalNotfall und Rettungsmedizin
Volume14
Issue number4
DOIs
StatePublished - May 2011
Externally publishedYes

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