vitamin-k-semiquinone-radical and Craniocerebral-Trauma

Guidelines advise performing a computed tomography head scan for all anticoagulated head injured patients, but the risk of intracranial haemorrhage (ICH) after a minor head injury is unclear. We conducted a systematic review and meta-analysis to determine the incidence of ICH in anticoagulated patients presenting with a minor head injury and a Glasgow Coma Score (GCS) of 15. We followed Meta-Analyses and Systematic Reviews of Observational Studies guidelines. We included all prospective studies recruiting consecutive anticoagulated emergency patients presenting with a head injury. Anticoagulation included vitamin-K antagonists (warfarin, fluindione), direct oral anticoagulants (apixaban, rivaroxaban, dabigatran and edoxaban) and low molecular weight heparin. A total of five studies (including 4080 anticoagulated patients with a GCS of 15) were included in the analysis. The majority of patients took vitamin K antagonists (98·3%). There was significant heterogeneity between studies with regards to mechanism of injury and methods. The random effects pooled incidence of ICH was 8·9% (95% confidence interval 5·0-13·8%). In conclusion, around 9% of patients on vitamin K antagonists with a minor head injury develop ICH. There is little data on the risk of traumatic intracranial bleeding in patients who have a GSC 15 post-head injury and are prescribed a direct oral anticoagulant.

Topics: Anticoagulants; Craniocerebral Trauma; Factor Xa Inhibitors; Female; Heparin, Low-Molecular-Weight; Humans; Incidence; Intracranial Hemorrhages; Male; Prospective Studies; Vitamin K

Topics: Africa; Birth Injuries; Blood Transfusion; Clinical Trials as Topic; Craniocerebral Trauma; Female; Hematoma; Humans; Hyperbilirubinemia; Infant, Newborn; Male; Pregnancy; Scalp; Vitamin K; Vitamin K Deficiency Bleeding

The number of patients with traumatic intracranial hemorrhage (tICH) that are taking antithrombotics (ATs), antiplatelets (APs) and/or anticoagulants (ACs), has increased, but the influence of it for outcome remains unclear. This study aimed to evaluate an influence of AT for tICH. We retrospectively reviewed all patients with tICH treated between 2012 and 2019, and analyzed demographics, neurological status, clinical course, radiological findings, and outcome data. A total of 393 patients with tICH were included; 117 were on AT therapy (group A) and 276 were not (group B). Fifty-one (43.6%) and 159 (57.6%) patients in groups A and B, respectively, exhibited mRS of 0-2 at discharge (p = 0.0113). Mortality at 30 days was significantly higher in group A than in group B (25.6% vs 16.3%, p = 0.0356). Multivariate analysis revealed that higher age (OR 32.7, p < 0.0001), female gender (OR 0.56, p = 0.0285), pre-injury vitamin K antagonist (VKA; OR 0.42, p = 0.0297), and hematoma enlargement (OR 0.27, p < 0.0001) were associated with unfavorable outcome. AP and direct oral anticoagulant were not. Hematoma enlargement was significantly higher in AC-users than in non-users. Pre-injury VKA was at high risk of poor prognosis for patients with tICH. To improve outcomes, the management of VKA seems to be important.

Topics: Aged; Aged, 80 and over; Anticoagulants; Craniocerebral Trauma; Female; Fibrinolytic Agents; Humans; Intracranial Hemorrhage, Traumatic; Japan; Male; Middle Aged; Platelet Aggregation Inhibitors; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Vitamin K

Topics: Aged; Aged, 80 and over; Craniocerebral Trauma; Emergency Service, Hospital; Factor Xa Inhibitors; Female; Humans; Intracranial Hemorrhages; Male; Retrospective Studies; Tomography, X-Ray Computed; Vitamin K

The correlation between direct oral anticoagulants (DOACs) or Vitamin K Antagonist (VKAs) intake and the incidence of intracranial complications after minor head injury (MHI) is still object of debate: preliminary observation seems to demonstrate lower incidence in intracranial bleeding complications (ICH) in patients taking DOACs than VKA. METHODS. This prospective and observational study was performed to clarify the incidence of ICH in patients in DOACs compared to VKAs. Between January 2016 and April 2018 we have recorded in our ED patients with MHI taking oral anticoagulants. Their hemorragic risk score was calculated and recorded for each patient (Has Bled, Atria and Orbit). RESULTS A total of 402 patients with MHI taking anticoagulant were collected: 226 were receiving one of the four DOACs (dabigatran, rivaroxaban, apixaban or edoxaban) while 176 patients were in therapy with VKA. The rate of intracranial complications was significantly lower in patients receiving DOACs than in patients treated with VKA (p < 0.01). In the VKA group two patients died because of intracranial bleeding. No deaths were recorded in the DOACs group. DISCUSSION patients with MHI who take DOACs have a significant lower incidence of intracranial bleeding complications than those treated with vitamin k antagonists. This statement is supported by the observation that the hemorrhagic risk, measured according to the chosen scores, was similar between the two groups.

Topics: Aged; Aged, 80 and over; Anticoagulants; Craniocerebral Trauma; Dabigatran; Female; Humans; Intracranial Hemorrhages; Male; Middle Aged; Pyrazoles; Pyridines; Pyridones; Risk; Rivaroxaban; Thiazoles; Vitamin K; Warfarin

Abusive head trauma is a serious, often fatal condition; early identification is important to prevent repeat episodes and/or injuries to siblings. This case emphasizes the importance of a thorough workup in cases of suspected abusive head trauma.. A 4-month-old infant was found to have a severe subdural hematoma requiring surgical evacuation. Initially, abusive head trauma was considered as a diagnosis. Testing revealed vitamin K deficiency bleeding (VKDB) despite prophylactic vitamin K administration at birth. The infant eventually was diagnosed with progressive familial Iintrahepatic cholestasis type 2 (PFIC2).. Although VKDB is a known cause of infantile intracranial hemorrhage, PFIC has not been previously reported to cause severe VKDB resulting in an intracranial hemorrhage.. Our case illustrates the importance of a comprehensive systematic approach to investigate causes other than abusive head injury when intracranial bleeding is a significant finding.

Topics: Child Abuse; Cholestasis, Intrahepatic; Craniocerebral Trauma; Diagnosis, Differential; Female; Hematoma, Subdural; Humans; Infant; Vitamin K

The correlation between chronic direct oral anticoagulants (DOACs) intake and the incidence of intracranial complications after minor head injury (MHI) is still not well defined. This study examined the incidence of complications in patients receiving vitamin K antagonists (VKA) or DOACs observed in the emergency department (ED) for MHI.. Two hundred twenty-five patients affected by MHI and receiving oral anticoagulants were recorded between January and December 2016, distinguishing those treated with VKA (118) from those receiving DOACs (107). All patients underwent a CT scan and were observed for 24h in the ED. Follow-up was performed up to 1month after the head trauma.. The rate of intracranial hemorrhage was significantly lower in patients treated with DOACs than in patients treated with VKA. We recorded 2 deaths among the 12 patients who experienced intracranial complications in the VKA group.. DOACs seem to have a more favorable safety profile than VKA in patients affected by MHI. This observation is important in light of the increasing number of elderly patients who are receiving anticoagulant therapy.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Craniocerebral Trauma; Female; Humans; Intracranial Hemorrhage, Traumatic; Italy; Male; Middle Aged; Prospective Studies; Risk Factors; Tomography, X-Ray Computed; Venous Thromboembolism; Vitamin K

Vitamin K antagonist (VKA) treatment is associated with significant risks and requires strict monitoring by measuring the international normalized ratio (INR), either by conventional methods or by self-measurement under medical supervision. We present a case of blindness occurring secondary to a moderate head injury, in a pediatric setting with no VKA therapeutic education.. A 7-year-old child with a single ventricle had been operated on for a total cavopulmonary shunt at the age of 5 years. He took VKA therapy with an INR target between 2 and 3. After a head trauma, he had a frontal hematoma. His parents did not request a medical exam and did not check his INR. Six days after the injury, the INR was 2.23. The parents went to the emergency ward because the child had bilateral orbital hematoma. At admission, the INR was 5.6. The orbital hematoma was surgically evacuated in the emergency setting. Unilateral blindness occurred and remains a sequelae of the overdose.. VKA treatment requires close supervision to prevent overdose, whose complications such as internal bleeding can have terrible consequences such as the case of blindness reported herein. This case report is a strong argument in favor of an educational program for children with VKA treatment.

Topics: Anticoagulants; Blindness; Child; Craniocerebral Trauma; Drug Overdose; Heart Defects, Congenital; Hematoma; Humans; Male; Monitoring, Physiologic; Patient Education as Topic; Prognosis; Retrobulbar Hemorrhage; Thromboembolism; Treatment Failure; Treatment Outcome; Vitamin K

Jehovah's Witness followers do not accept blood derived transfusions and available methods for avoiding transfusion have been used with degrees of success, demonstrating that the probability of death after trauma in these patients may not be significantly different from religious groups. In this report, we describe the case of a child victim of a multiple trauma with severe anemia due to blood loss, whose family would not authorize blood transfusion because of their Jehovah's Witness faith. We discuss the current indications for restricting transfusion, as well as highlighting new tools that contribute to the success of minimizing blood loss, thus avoiding transfusion.

Topics: Accidents, Traffic; Anemia; Anti-Bacterial Agents; Case Management; Child; Colloids; Combined Modality Therapy; Craniocerebral Trauma; Crystalloid Solutions; Culture; Debridement; Dopamine; Erythropoietin; Ferric Compounds; Fluid Therapy; Folic Acid; Hemorrhage; Humans; Isotonic Solutions; Jehovah's Witnesses; Male; Multiple Trauma; Plasma Substitutes; Vitamin K

Topics: Birth Injuries; Birth Weight; Craniocerebral Trauma; Female; Hematoma; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intramuscular; Male; Punctures; Sex Factors; Vitamin K; Vitamin K Deficiency

Topics: Accidents, Traffic; Adult; Anticoagulants; Craniocerebral Trauma; Female; Heparin; Humans; Thromboembolism; Tibial Fractures; Vitamin K; Wounds and Injuries