None of the authors have any conflicts of interest or special declarations to make regarding the contents of this manuscript.
MB directed the design of the study, data interpretation, and was involved in the drafting and revision of the manuscript. EI was involved in the study design and the manuscript revision. PR was involved in the data acquisition, study planning, and manuscript revision. RR was involved in the data interpretation and manuscript revision. PH was involved with the data acquisition and the data interpretation. All authors read and approved the final manuscript.
Therapeutic anticoagulation is an important treatment of thromboembolic complications, such as DVT, PE, and blunt cerebrovascular injury. Traumatic intracranial hemorrhage has traditionally been considered to be a contraindication to anticoagulation.
Therapeutic anticoagulation can be safely accomplished in select patients with traumatic intracranial hemorrhage.
Patients who developed thromboembolic complications of DVT, PE, or blunt cerebrovascular injury were stratified according to mode of treatment. Patients who underwent therapeutic anticoagulation with a heparin infusion or enoxaparin (1 mg/kg BID) were evaluated for neurologic deterioration or hemorrhage extension by CT scan.
There were 42 patients with a traumatic intracranial hemorrhage that subsequently developed a thrombotic complication. Thirty-five patients developed a DVT or PE. Blunt cerebrovascular injury was diagnosed in four patients. 26 patients received therapeutic anticoagulation, which was initiated an average of 13 days after injury. 96% of patients had no extension of the hemorrhage after anticoagulation was started. The degree of hemorrhagic extension in the remaining patient was minimal and was not felt to affect the clinical course.
Therapeutic anticoagulation can be accomplished in select patients with intracranial hemorrhage, although close monitoring with serial CT scans is necessary to demonstrate stability of the hemorrhagic focus.