Coming in a future issue of Annals, the Editor’s capsule summary: “Delayed intracranial hemorrhage is common after minor head injury when patients are receiving warfarin. A minimum protocol of 24-hour observation followed by repeated scanning is necessary to detect most such occurrences.”
Or they have an observational case series consisting of 87 patients from Italy.
These authors present a prospective case series of all patients at their institution who were admitted for observation specifically for minor head trauma while on oral anticoagulation. At the time of repeat CT scanning 24 hours later, the authors report five of them had new bleeding detected. In addition, two patients who were discharged after two negative CT scans returned with symptomatic bleeding, one at two days, and one at eight days.
Clearly, some patients will have delayed bleeding – a subset of which will be clinically significant. However, we simply cannot expose all anticoagulated patients with minor head trauma to the harms and costs of hospitalization. Better studies are required to prospectively determine the risk profile of patients who require further observation in a hospital setting, rather than a watchful discharge home.