Raphael Jaewon Yoo MS, MD, Presenter: Nothing to Disclose

Joann Lee, Abstract Co-Author: Nothing to Disclose

Wendy Kim MD, Abstract Co-Author: Nothing to Disclose

Lulu He DO, Abstract Co-Author: Nothing to Disclose

Khuram Shahzad Kazmi MD, Abstract Co-Author: Nothing to Disclose

To report the incidence of delayed intracranial hemorrhage (ICH) in trauma patients on anti-coagulation/antiplatelet therapy on repeat head CT performed 12-24 hours after an initial negative scan.

A retrospective review was performed at our institution for patients that met the following criteria: 1) the patient was admitted to the trauma service, 2) prior to injury the patient was on an antiplatelet/anticoagulation regimen, 3) initial head CT demonstrated no evidence of ICH, and 4) a follow-up head CT was performed within 12-24 hours. Additional patient data reviewed in our study includes: age, gender, mechanism of injury, and anticoagulant/antiplatelet agent.

Our inclusion criteria were met by 403 patients. Data regarding patient characteristics are included in the attached figure. Of the 403 patients, only 2 patients demonstrated ICH on repeat head CT. Patient 1 was a 78 year old female who fell while on aspirin and clopidogrel and developed a small hemorrhage in the left thalamus. She did not require neurosurgical intervention. Patient 2 was an 81 year old female who fell while on clopidogrel. She had an old craniectomy defect from prior trauma. Initial CT was negative, but she developed a subdural hematoma on repeat CT, which also resolved without neurosurgical intervention.  

Based on a delayed ICH rate of 4% in their cohort of 100 patients, Tauber et al. (2009) recommends that all patients over 65 years old taking low-dose ASA therapy who present with trauma should receive a repeat head CT in 12-24 hours or in-hospital observation for 48 hours. Two subsequent studies by Menditto et al (2012) and Peck et al (2011) of 511 patients on warfarin or clopidogrel demonstrate incidences of delayed ICH of 6% and 1%, respectively. All of the 11 positive cases in these studies were patients on warfarin and 9 of those 11 had INR greater than 2.0. Our data of 403 patients on all types of anticoagulant or antiplatelet therapies demonstrates an incidence of only 0.5% suggesting that repeat head CT is not indicated for all patients. Factors such as age, neurologic deterioration, GCS scores or INR (for those on warfarin) may be helpful in identifying patients at higher risk of developing delayed ICH.  

Our data suggests the incidence of delayed ICH in patients on anticoagulation and antiplatelet therapies is low. Other patient factors should be examined to determine who should be reimaged.

Yoo, R, Lee, J, Kim, W, He, L, Kazmi, K, Delayed Intracranial Hemorrhage on Repeat Head CTs in Trauma Patients on Anti-Coagulation and Anti-Platelet Agents.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028881.html