Popular Blood Thinners May Lead to Brain Bleeding and Death After Head Injury

 

According to research at the annual meeting of the Radiological Society of North America (R S N-A), a three-year study involving more than 1,000 patients found that adults taking older blood-thinning medications such as clopidogrel (Plavix) and warfarin (Coumadin) had a significantly higher risk of delayed intracranial hemorrhage and death following head trauma. There is a possibility that the risk of delayed hemorrhage will rise if you take aspirin along with any blood thinner. 

When blood vessels in the brain rupture, releasing blood into the brain tissue, this is known as an intracranial hemorrhage. After an initial negative head CT, bleeding in the brain occurs in a delayed traumatic intracranial hemorrhage, typically within 48 hours of the initial trauma.

An injury to the head, high blood pressure, and taking blood thinners are all known to cause intracranial bleeding. Patients taking blood thinners are on the rise as the population ages. 

Warren Chang, MD, a neurobiologist and director of research at the Imaging Institute of the Allegheny Health Network in Pennsylvania, stated, "The incidence of delayed post-traumatic intracranial hemorrhage in patients on different types of blood thinners with and without the addition of aspirin is not well established". This is a hotly debated topic, particularly in light of the increasing use of novel blood thinners. Adults who are taking blood thinners and suffer a head injury usually require CT brain imaging. The standard of care, however, beyond initial imaging, is unclear. While some hospitals may discharge a patient who does not have intracranial hemorrhage and is in stable condition, others may admit them for observation and subsequent CT imaging

This study included blood thinner-taking patients with head trauma who underwent CT imaging at the Allegheny Health Network. Twenty patients experienced delayed bleeding, and there were three deaths at a rate of 0.3, the warfarin/clopidogrel/older blood thinner group was responsible for all deaths in the study group

345 patients in the entire study group were taking both aspirin and blood thinners. Of the 20 patients who experienced a postponed drain, 15 were taking a more established sort of blood thinner, and nine of the 15 were likewise taking ibuprofen. 

Dr Chang stated, "Compared to patients taking novel drugs, the rate of delayed hemorrhage was higher in patients taking older blood thinners and significantly higher in patients taking aspirin in addition to the older medications". 

Four of the five patients who had a delayed hemorrhage and were taking novel blood thinners were also taking aspirin. 

According to Thomas Campbell, MD, MPH, the Allegheny Health Network's system chair for emergency medicine, "This study will help to guide our care of closed head injury patients in emergency medicine and support efforts to use imaging resources appropriately" given the high volume of trauma patients taking aspirin and anticoagulants. 

The authors of the study recommend a follow-up CT for patients who are taking any blood thinner in addition to aspirin and who did not suffer an initial intracranial hemorrhage as a result of head trauma. Patients who only take one of the more recent blood thinners and do not take aspirin do not need to have a follow-up CT scan unless there are visible signs of trauma on the outside. 

He stated, "Taking one of the novel medications without aspirin significantly reduced the risk of delayed hemorrhage, while taking any blood thinner concurrently with aspirin significantly increased the risk". 

This study shows how effective patient care can be driven by cutting-edge imaging. Bethany Casagranda, DO, chair of the Imaging Institute of the Allegheny Health Network, stated, "I believe the recommendations of this work will ultimately save many lives"