Limited benefit of systematic head CT for mild traumatic brain injury in patients under antithrombotic therapy - 23/02/21

Doi : 10.1016/j.neurad.2021.02.004

Lucie Colas ^a,⁎ , Sahara Graf ^b , Juliette Ding ^a , Gregory Bertolotti ^c , Nicolas Thellier ^c , Jean-François Budzik ^a , Sebastien Verclytte ^a
^a Imaging Department, Lille Catholic Hospitals, Lille Catholic University, F-59000, Lille, France
^b Biostatistics Department – Delegation for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, F-59000, Lille, France
^c Emergency Department, Lille Catholic Hospitals, Lille Catholic University, F-59000, Lille, France

^⁎Corresponding author at: Imaging Department, Lille Catholic Hospitals, Boulevard de Belfort, 59000 Lille, France.Imaging DepartmentLille Catholic HospitalsBoulevard de BelfortLille59000France

En prensa. Manuscrito Aceptado. Disponible en línea desde el Tuesday 23 February 2021
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Graphical abstract

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Highlights

•	The rate of intracranial hemorrhage in mTBI patients under antithrombotic therapy was 5.8%, mostly with minor severity (81.6%).
•	No severe-grade lesion was found, no death occurred and no neurosurgical care was needed.
•	No evidence to link the anti-thrombotic treatment management to the IH outcome was found, but a potential over-risk of thrombotic complications in case of treatment interruption was detected.

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Abstract

Background and purpose

Mild traumatic brain injury (mTBI) in patients on antiplatelet (AP), anticoagulant (AC) or direct oral anticoagulant (DOAC) medication has become a systematic indication for head CT. However, the over-risk and impact of the intracranial hemorrhages (IH) detected with CT in this population remain unclear and need to be assessed.

Materials and methods

We prospectively assessed head CTs performed in adults taking AP/AC/DOAC referred after a mTBI to our Emergency Departments between September 2016 and January 2018. Frequency, type and severity of IH were described and frequency was analyzed as a function of treatment.

Results

840 patients were prospectively included. 58.9% were treated with AP, 23.7% with AC, 11.7% with DOAC and 5.7% with a combination of antithrombotic agents. The rate of IH detected with head CT was 5.8% (n = 49), of which 81.6% (n = 40) and 18.4% (n = 9) with minor and intermediate severity respectively. No patient required surgical care and no death occurred. No statistically significant difference was found in treatment distribution between patients with or without IH (p = 0.98). Among the patients who discontinued their antithrombotic treatment after mTBI, three experienced thrombotic events during the hospitalization.

Conclusions

Our results showed a low frequency and severity of IH in mTBI patients indifferently treated with AP, AC or DOAC, without secondary neurological deterioration, death or need of surgical care. Our study suggests the limited benefit of systematic CT head scan as a standard practice for the management of mTBI patients under antithrombotic therapy.

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Keywords : Mild traumatic brain injury, Traumatic cerebral hemorrhage, Anticoagulants, Platelet aggregation inhibitors, Tomography, Spiral computed