The thinner the blood, the harder they fall

File:Denslow's Humpty Dumpty 1904.jpg

Three questions come up again and again when you are stratifying risk after head injury:


1. Was there a headstrike?
2. Was there a change in consciousness?
3. Is the patient on an anti-coagulant?


It’s often thought that patients who present with a GCS of 15 are at lower risk – but when you find out they are on warfarin, it always throws that bit of doubt into your mind…



This article from the Journal of Trauma looked at patients who had a fall while on anticoagulants (warfarin or clopidogrel) who presented with a pristine GCS and looked at the risk of intracranial haemorrhage – and the numbers aren’t great.


Out of 141 patients:

  • 41 (29%) had an intracranial haemorrhage
    • 19 subdurals
    • 14 subarachnoid
  • 5 required surgery
  • 4 died (although 2 were from other causes)
Of course, loss of consciousness was a very strong predictor of a positive CT result, but interestingly enough, the type of anti-coagulant medication didn’t quite reach statistical significance as a predictor. In fact, mechanism of injury and presence of fracture weren’t predictors here either. 

Even with minor head trauma, beware the anticoagulant – read the article over here



IMAGE: William Denslow

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