So, do you admit all patients on warfarin who have had a minor head injury
with no LOC? e.g. 1 cm superficial cut over forehead glued and no symptoms?
If they are admitted I presume they would have to travel by ambulance from
Bridlington to Scarborough for HI obs?
I have similar problems with distances re Kendal and Lancaster 23 miles
away.
Ray
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, February 01, 2002 7:17 PM
Subject: Warfarin and Minor head Injury
> I published a little paper in JAEM May 98, vol15(3)p159-161 on this topic.
It
> was based on a clinical topic review for the FFAEM. We had 3 departmental
cases
> of intracranial bleeding in warfarinised patients with minor head injuries
in
> 3 months. Two of three had INR of 2.2. The other was not recorded. All had
symptoms
> especially headache, on first attending. I found 8 other cases published.
These
> all had significantly raised INR (above planned levels)or symptoms. My
reading
> suggests that being on warfarin is supposed to raise the risk of
spontaneous
> haemorrahge by 10 ( NO RCT). I applied the 10 factor to the Glasgow risk
of
> ICH in head injury: Fully orientated , no fracture 1:800 Confused, no
fracture
> 1:18, Orientated plus fracture 1:4, Confused plus fracture 2:1!! My bottom
line
> is Head injury plus warfarin, check INR. If elevated out of treatment
range,
> admit under medics for control. If normal treatment range, any symptoms
need
> CT. The timing of this is not clear, since bleeding may occur after the CT
but
> treat a symptomatic patient seriously and have a low threshold for scan. I
need
> a trial to see if this helps, but given each A&E only sees a couple of
these
> a year, I haven't managed to organise such a study. Any of you academics
out
> there looking for a project? I am sure we could tame a neurosurgeon
sufficiently
> to get a retrospective study of warfarin and ICranialH (EDH, SDH and ICH.
When
> I was SR the local team were keen but had terrible record storage making
it
> impossible to find cases.
>
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