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Risk of cerebral hemorrhage in mild traumatic brain injury and antithrombotic treatment
J J Martínez-Rivas1, F Rodríguez-Lucas1, G Planells1
1Servicio de urgencias, Hospital General de Granollers, Barcelona, Spain.
Introduction:
The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment.
Method:
We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with ≥1 risk factor at admission and at 24 h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed.
Results:
We evaluated 907 patients with a mean age of 73 ± 19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24 h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs 11.9% without treatment, p = 0.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24 h, 3 were asymptomatic and one case that worsened the initial headache. No asymptomatic patient without lesion on initial clinical cranial CT presented at 24 h.
Conclusions:
Our study suggests that patients with asymptomatic mTBI, without a lesion on the initial cranial CT, would not require the observation period or CT control regardless of antithrombotic treatment or INR level.
Insights
Mild traumatic brain injury (mTBI) patients without initial CT lesions do not need observation, even if on antithrombotic treatment. This finding simplifies management for asymptomatic mTBI cases.
Area of Science:
- Neurology
- Emergency Medicine
- Radiology
Background:
- The optimal observation period for mild traumatic brain injury (mTBI) remains debated.
- Antithrombotic treatment in mTBI patients adds complexity to management decisions.
Purpose of the Study:
- To evaluate the risk of neurological complications in mTBI patients undergoing antithrombotic treatment.
- To determine if antithrombotic therapy increases hemorrhage risk in mTBI.
Main Methods:
- Retrospective evaluation of 907 mTBI patients (Glasgow score ≥13) over 3 years.
- Cranial CT scans were performed based on risk factors and neurological status.
- Complications within 3 months were reviewed, with a focus on hemorrhage and antithrombotic use.
Main Results:
- 11% of patients had initial brain hemorrhage; only 0.4% at 24 hours and none at 3 months.
- Antithrombotic treatment did not significantly increase brain hemorrhage risk (9.9% vs. 11.9%).
- Most hemorrhages (78.4%) were mild, and asymptomatic patients without initial CT lesions showed no delayed complications.
Conclusions:
- Asymptomatic mTBI patients with negative initial CT scans may not require observation or repeat CT.
- This approach is valid regardless of antithrombotic treatment or INR levels.
- Simplifying observation protocols can improve patient management and resource allocation.
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