2021 Head Injury Guidelines for Patients on Direct Oral Anticoagulants (DOACs): Case
The American Academy of Emergency Medicine (AAEM) published a clinical practice statement in April 2021 addressing the risk of delayed intracranial hemorrhage after a mild traumatic brain injury in patients taking direct oral anticoagulants (DOACs). What does these 2021 head injury guidelines recommend with regards to routine repeat Head CT scans in this subpopulation?
Today’s Guideline Knowledge Check question comes from the desk of Med-Challenger Emergency Medicine Editor-in-Chief, Andrea Eberly, MD, FAAEM.
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Try this review question and find out if you’re following the most current 2021 head injury guidelines.
An 84-year-old male presents to the emergency department (ED) after falling in the bathroom and hitting his head on a tile floor.
The fall was due to a loss of balance.
He did not lose consciousness and presents now with a 4-cm hematoma on the forehead at the lateral prominence of the left supraorbital ridge.
He is neurologically intact except for chronic gait instability secondary to spinal stenosis.
He takes a direct oral anticoagulant, but no anti-thrombotic medication.
A head CT scan without contrast is negative.
Which of the following statements is true regarding a delayed second head CT scan in this patient anticoagulated through DOACs if he remains neurologically intact?
The data is currently not strong enough to formally recommend for or against repeat imaging.
A second computed tomography (CT) of the head after 3 hours is recommended.
The patient should be observed in the ED for 3 hours; if there is no neurological deterioration, the patient can be discharged without a second head CT scan.
Different from patients on vitamin K inhibitors (e.g. warfarin), patients on DOACs do not require a repeat head CT or an observation period after minor head trauma and a negative first head CT scan.
See the Answer:
About Guideline Knowledge Checks:
With each update of national clinical practice guidelines, some recommendations change and many remain unchanged. Med-Challenger Guideline Knowledge Checks help you know both what is new and what has stayed the same in the most recent guidelines pertinent to each medical specialty.
About the Author:
Andrea Eberly, MD, FAAEM graduated from the David Geffen Medical School of Los Angeles (UCLA) and completed her residency in Emergency Medicine at the University Medical Center, Tucson, Arizona. After working as an attending physician in Tucson, she followed a recruiting call to the island of Guam, where she served in various roles, including as the director of the emergency department, the EMS Medical Director of Guam, and the Director of the 911 Call System. She has maintained her emergency medicine board certification through three cycles of American Board of Emergency Medicine Board Exams (last in 2014), all three with the help of Med-Challenger.
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