Observational studyThe Permanente journal2016
Risk of Delayed Intracerebral Hemorrhage in Anticoagulated Patients after Minor Head Trauma: The Role of Repeat Cranial Computed Tomography.
Observational study in The Permanente journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 3 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- Evidence-based indications for repeat head CT after mild traumatic brain injury: a systematic review and meta-analysis.Neurosurgical review · 2025Pooled it
- Incidence of intracranial bleeding in mild traumatic brain injury patients taking oral anticoagulants: a systematic review and meta-analysis.Journal of neurology · 2024Pooled it
- Incidence of delayed bleeding in patients on antiplatelet therapy after mild traumatic brain injury: a systematic review and meta-analysis.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Pooled it
- Article
- Incidence and outcomes of delayed intracranial hemorrhage: a population-based cohort study.Scientific reports · 2024Article
- In old anticoagulated patients with mild traumatic brain injury, a 24-h observation period should not be recommended without evidence of a clear benefit: a retrospective study of delayed hemorrhagic versus iatrogenic complications.Internal and emergency medicine · 2024Article
- Impact of antithrombotic therapy on acute and delayed intracranial haemorrhage and evaluation of the need of short-term hospitalisation based on CT findings after mild traumatic brain injury: experience from an oral and maxillofacial surgery unit.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Observational
- Value of Repeat CT Brain in Mild Traumatic Brain Injury Patients with High Risk of Intracerebral Hemorrhage Progression.International journal of environmental research and public health · 2022Article
- Article
- Reappraising the need for a control CT in mild head injury patients on anticoagulation.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2021Observational
- Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists.Medicina (Kaunas, Lithuania) · 2020Observational
- Antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries.Trauma surgery & acute care open · 2020Article
- Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy.Journal of clinical medicine · 2019Article
- Evaluation of Clinical Criteria for Performing Brain CT-Scan in Patients with Mild Traumatic Brain Injury; A New Diagnostic Probe.Bulletin of emergency and trauma · 2019Article
- Diagnostic and therapeutic approach in adult patients with traumatic brain injury receiving oral anticoagulant therapy: an Austrian interdisciplinary consensus statement.Critical care (London, England) · 2019Article
- Delayed intracranial hemorrhage in elderly anticoagulated patients sustaining a minor fall.BMC emergency medicine · 2018Article
- Head injury while on anticoagulation: Small numbers, big risks.Neurology. Clinical practice · 2017Article
- Mild brain injury and anticoagulants: Less is enough.Neurology. Clinical practice · 2017Article
- Acute and Delayed Intracranial Hemorrhage in Head-Injured Patients on Warfarin versus Direct Oral Anticoagulant Therapy.Journal of emergencies, trauma, and shockArticle
- Management of Mild Brain Trauma in the Elderly: Literature Review.Asian journal of neurosurgeryReview
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextPatients receiving anticoagulant medications who experience minor head injury are at increased risk of an intracerebral hemorrhage (ICH) developing, even after an initial computed tomography (CT) scan of the brain yields normal findings. Conflicting evidence exists regarding the frequency at which delayed bleeding occurs.
objectiveTo identify the frequency of delayed traumatic ICH in patients receiving warfarin or clopidogrel.
designWe performed a retrospective observational study of adult trauma encounters for anticoagulated patients undergoing head CT at 1 of 13 Kaiser Permanente Southern California Emergency Departments (EDs) between 2007 and 2011. Encounters were identified using structured data from electronic health and administrative records, and then records were individually reviewed for validation of results.
main outcome measuresThe primary outcome measure was ICH within 60 days of an ED visit with a normal head CT result.
resultsOur sample included 443 (260 clopidogrel and 183 warfarin) eligible ED encounters with normal findings of initial head CT. Overall, 11 patients (2.5%, 95% confidence interval [CI] = 1.4%-4.4%) had a delayed ICH, and events occurred at similar rates between the clopidogrel group (6/260, 2.3%, CI 1.1%-5.0%) and warfarin group (5/183, 2.7%, CI 1.2%-6.2%).
conclusionTrauma patients in the ED who are receiving warfarin or clopidogrel have approximately a 2.5% risk of delayed ICH after an initial normal finding on a head CT.
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