I have started 'collecting' patients prospectively as of yesterday, heh! I
don't expect numbers to be great as our catchment area here is quite young,
but what I am thinking of doing is scanning all warfarin patients at least
after 4 hours (or sooner if indicated) and keeping those in who are just
'not quite right' even after the scan. Any better suggestions?
Thanks
Robert Spykerman
Reg, ED, Cork University Hospital
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, January 31, 2002 10:19 PM
Subject: Warfarin and minor head injury
> A sobering personal experience has convinced me to CT scan all G.C.S 15
head
> injury patients on warfarin independent of their PT-INR.If its an acute
presentation
> it means a CT Head and admission for observation till improvement of the
minor
> symptoms(usually headache)with consideration to a repeat scan if symptoms
worsen.If
> its a delayed presentation(few days after the injury) its CT head and home
if
> scan is normal with usual HI advise.On evidence,a fellow registrar(now
consultant)did
> one of his topic reviews on the subject of management of warfarinised
patients
> with minor head injury and might want to share his opinion with the
list(unless
> he has already submitted it for publication!)To my knowledge,there are no
prospective
> studies only case reports and retrospective record reviews.The latest I
found
> was a research letter by Li and Brown reported in the Lancet(THE LANCET
Vol
> 357 March 10 2001)recommending CT scan in all patients with head injury
receiving
> anticoagulants.It refuted the earlier work by Garra(Minor head injury in
the
> warfarinised patient-Acad Emergency Med 1999 Feb;6(2) 121-4)which seemed
to
> suggest CT scan may be unnecessary in the anticoagulated patient with
minor
> blunt head injury.Personally I don't see the numbers being large if we did
go
> ahead and scan all those who present and it could be part of a multi
centre
> prospective trial to settle the question once and for all.I suggest we
call
> it the WITHMI Study(Warfarin In Traumatic Head-Minor Injury).Are you with
me?
>
> Dilip Menon
> North Wales
>
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