Repeat head computed tomography in anticoagulated traumatic brain injury patients: Still warranted

Bellal Joseph, Moutamn Sadoun, Hassan Aziz, Andrew Tang, Julie L. Wynne, Viraj Pandit, Narong Kulvatunyou, Terence OKeeffe, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CTwith prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using x2 and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P\0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P\0.001), were more likely to present with an abnormal neurologic examination (P 5 0.004), and had higher hospital and intensive care unit lengths of stay (P\0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P\0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.

Original languageEnglish (US)
Pages (from-to)43-47
Number of pages5
JournalAmerican Surgeon
Issue number1
StatePublished - Jan 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)


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