I see an ICB on warfarin detriorate and die in the ED
every six months. I scan them all. Admission is
pointless - either they have an expanding haematoma or
they dont, and my experience is that they go downhill
so rapidly you'll miss the opportunity to get them to
neurosurgery if you don't
--- [log in to unmask] wrote:
> 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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