Limited benefit of systematic head CT for mild traumatic brain injury in patients under antithrombotic therapy.

Abstract

BACKGROUND AND PURPOSE:

Mild traumatic brain injury (mTBI) in patients on antiplatelet (AP), anticoagulant (AC) or direct oral anticoagulant (DOAC) medication has become a systematic indication for head CT. However, the over-risk and impact of the intracranial hemorrhages (IH) detected with CT in this population remain unclear and need to be assessed.

MATERIALS AND METHODS:

We prospectively assessed head CTs performed in adults taking AP/AC/DOAC referred after a mTBI to our Emergency Departments between September 2016 and January 2018. Frequency, type and severity of IH were described and frequency was analyzed as a function of treatment.

RESULTS:

840 patients were prospectively included. 58.9% were treated with AP, 23.7% with AC, 11.7% with DOAC and 5.7% with a combination of antithrombotic agents. The rate of IH detected with head CT was 5.8% (n...=...49), of which 81.6% (n...=...40) and 18.4% (n...=...9) with minor and intermediate severity respectively. No patient required surgical care and no death occurred. No statistically significant difference was found in treatment distribution between patients with or without IH (p...=...0.98). Among the patients who discontinued their antithrombotic treatment after mTBI, three experienced thrombotic events during the hospitalization.

CONCLUSIONS:

Our results showed a low frequency and severity of IH in mTBI patients indifferently treated with AP, AC or DOAC, without secondary neurological deterioration, death or need of surgical care. Our study suggests the limited benefit of systematic CT head scan as a standard practice for the management of mTBI patients under antithrombotic therapy.

• Authors: Lucie Colas, Sahara Graf, Juliette Ding, Gregory Bertolotti, Nicolas Thellier, Jean-Fran Ois Budzik, Sebastien Verclytte
• Journal: Journal of neuroradiology = Journal de neuroradiologie (J Neuroradiol) Vol. 50 Issue 1 Pg. 30-35 (Feb 2023) ISSN: 0150-9861 [Print] France
• PMID: 33636220 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Elsevier Masson SAS. All rights reserved.

Chemical References

• Fibrinolytic Agents
• Anticoagulants

Topics

• Adult
• Humans
• Brain Concussion (chemically induced, drug therapy)
• Fibrinolytic Agents (therapeutic use)
• Retrospective Studies
• Anticoagulants (therapeutic use)
• Intracranial Hemorrhages
• Tomography, X-Ray Computed