I'd agree that you shouldn't just treat the scan, but a patient on warfarin
with an acute subdural or intracerebral haematoma can deteriorate rapidly.
Should they not be observed by the neurosurgeons?...... if the neurosurgeons
have any intention of operating?
Also waiting for the GCS to deteriorate on someone who has deteriorating
neurological signs is inadvisable. Example of not treating the scan or the
patient. If one waits for the GCS to start deteriorating the prognosis may
well be worse as there is an inevitable delay before getting to theatre
especially if the patient is not on the same site as neurosurgery.
Incidently my haematologists tell me that there is a new drug under
development to replace warfarin that doesn't need clotting checked... a bit
like low molecular weight heparin in that respect. No name yet.
Ray McGlone
A&E Lancaster
----- Original Message -----
From: "Adrian Kerner" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, February 02, 2002 10:51 PM
Subject: Re: Wafarinised head injuries
> The other point is if INR is controlled and ??small subdural - no surgery
> likely, with relatively normal patient, why scan? can we not base our
decisions
> on clinical parameters. i have yet to come across a neurosurgeon who is
really
> keen to stick knife into patient on warfarin with GCS 15 and little
symtoms.
>
> I do stand to be corrected - but we should treat the patient - not the
scan.
>
> And yes I do pertain to the idea of at least it gives some direction in
the
> management and stratifies risk etc - but this is an increasing problem.
>
> What % patients with MHI and GCS 15 and little symptoms end up with
surgical
> knife in head?
>
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