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Open AccessArticle

Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy

1
Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, 1090 Vienna, Austria
2
Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(11), 1780; https://doi.org/10.3390/jcm8111780
Received: 14 September 2019 / Revised: 9 October 2019 / Accepted: 23 October 2019 / Published: 25 October 2019
(This article belongs to the Special Issue Epidemiology, Significance and Complications of Orthopaedic Trauma)
Background: Delayed intracranial hemorrhage can occur up to several weeks after head trauma and was reported more frequently in patients with antithrombotic therapy. Due to the risk of delayed intracranial hemorrhage, some hospitals follow extensive observation and cranial computed tomography (CT) protocols for patients with head trauma, while others discharge asymptomatic patients after negative CT. Methods: We retrospectively analyzed data on patients with head trauma and antithrombotic therapy without pathologies on their initial CT. During the observation period, we followed a protocol of routine repeat CT before discharge for patients using vitamin K antagonists, clopidogrel or direct oral anticoagulants. Results: 793 patients fulfilled the inclusion criteria. Acetylsalicylic acid (ASA) was the most common antithrombotic therapy (46.4%), followed by vitamin K antagonists (VKA) (32.2%) and Clopidogrel (10.8%). We observed 11 delayed hemorrhages (1.2%) in total. The group of 390 patients receiving routine repeat CT showed nine delayed hemorrhages (2.3%). VKA were used in 6 of these 11 patients. One patient needed an urgent decompressive craniectomy while the other patients were discharged after an extended observation period. The patient requiring surgical intervention due to delayed hemorrhage showed neurological deterioration during the observation period. Conclusions: Routine repeat CT scans without neurological deterioration are not necessary if patients are observed in a clinical setting. Patients using ASA as single antithrombotic therapy do not require in-hospital observation after a negative CT scan. View Full-Text
Keywords: delayed intracranial hemorrhage; head trauma; traumatic brain injury; antithrombotic therapy delayed intracranial hemorrhage; head trauma; traumatic brain injury; antithrombotic therapy
MDPI and ACS Style

Antoni, A.; Schwendenwein, E.; Binder, H.; Schauperl, M.; Datler, P.; Hajdu, S. Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy. J. Clin. Med. 2019, 8, 1780. https://doi.org/10.3390/jcm8111780

AMA Style

Antoni A, Schwendenwein E, Binder H, Schauperl M, Datler P, Hajdu S. Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy. Journal of Clinical Medicine. 2019; 8(11):1780. https://doi.org/10.3390/jcm8111780

Chicago/Turabian Style

Antoni, Anna; Schwendenwein, Elisabeth; Binder, Harald; Schauperl, Martin; Datler, Philip; Hajdu, Stefan. 2019. "Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy" J. Clin. Med. 8, no. 11: 1780. https://doi.org/10.3390/jcm8111780

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Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

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