New imaging guidance for patients on common blood thinners who have suffered a head injury
Patients taking older blood-thinning medications face a greater risk of delayed intracranial hemorrhage and death after they’ve experienced a head injury, according to research presented Tuesday at RSNA. As a result, experts have developed new follow-up imaging recommendations for these adults.
As the population grows older, more and more patients are taking blood thinners. These medications, along with high blood pressure and head injury, are known to cause intracranial hemorrhage (ICH). And while those on thinning medications are typically sent for brain CT after a head injury, many organizations have different follow-up protocols.
“Some hospitals admit patients for observation and repeat CT imaging, while others may discharge a patient who does not have intracranial hemorrhage and is in stable condition,” Warren Chang, MD, a neuroradiologist and director of research at the Imaging Institute of the Allegheny Health Network in Pennsylvania, said in a statement.
To better understand this issue, Chang and colleagues reviewed data from 1,046 patients taking blood thinners who also sustained head trauma and underwent subsequent CT imaging between January 2017-2020. Only those whose initial scan was negative for ICH and also underwent follow-up imaging were included.
The final group included 576 individuals taking new medications (apixaban, rivaroxaban and dabigatran) and 470 prescribed older blood thinners such as warfarin, clopidogrel and another unnamed medicine. Patients were 77.5 years old on average.
Findings revealed 20 patients (1.9%) suffered delayed hemorrhage and three died from the condition. All deaths were among patients taking older medications.
Aspirin also played a prominent role in these adverse events, the authors noted. Out of the total cohort, 345 patients were taking blood thinners and aspirin. And of the 20 who experienced a delayed hemorrhage, 15 were taking an older medication, while 9 of those individuals were also taking aspirin.
After assessing their results, Chang et al. say they recommend performing follow-up CT for those who do not experience intracranial hemorrhage following head trauma and who are also taking an older blood thinner. They suggest the same approach for individuals taking aspirin with any type of blood-thinning medication.
At the same time, follow-up CT isn’t required for patients taking a single newer medication and who aren’t on aspirin.
“This study illustrates how innovative imaging can drive optimal patient care,” Bethany Casagranda, DO, chair of the Imaging Institute of the Allegheny Health Network, said Tuesday. “In the end, I believe the recommendations of this work will save many lives.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.