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August 2017; 7 (4) Research

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
First published June 22, 2017, DOI: https://doi.org/10.1212/CPJ.0000000000000375
Laura Campiglio
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Francesca Bianchi
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Claudio Cattalini
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Daniela Belvedere
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Chiara Emilia Rosci
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Chiara Livia Casellato
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Manuela Secchi
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Maria Cristina Saetti
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Elena Baratelli
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Alessandro Innocenti
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Ilaria Cova
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Chiara Gambini
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Luca Romano
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Gaia Oggioni
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Rossella Pagani
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Marco Gardinali
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Alberto Priori
III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy.
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Full PDF
Citation
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
Neurol Clin Pract Aug 2017, 7 (4) 296-305; DOI: 10.1212/CPJ.0000000000000375

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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.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Supplemental data at Neurology.org/cp

  • Editorial, page 280

  • Received December 29, 2016.
  • Accepted April 7, 2017.
  • © 2017 American Academy of Neurology
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