Who Needs CT? Aspirin, Clopidogrel, Warfarin, or a Combination?

April 21, 2020

Written by Clay Smith

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Patients with blunt head trauma taking warfarin or dual aspirin/clopidogrel therapy were at greater risk for significant intracranial injury on CT. Scan these people.

Why does this matter?
Patients often use aspirin or other antiplatelet or anticoagulant agents. Should the threshold to perform CT be the same in those taking an aspirin a day as opposed to those on warfarin or dual antiplatelet therapy?

Aspirin or clopidogrel alone did not increase risk.
This was a large, multicenter prospective study of adult patients with blunt head trauma requiring CT, comparing those without anticoagulation or antiplatelet agents to those with them. They enrolled 9,070 patients. Relative risk for significant intracranial injury on CT, such as bleeding, cerebral edema, or skull fracture, was 1.88 (1.28 to 2.75) for patients taking warfarin and 2.88 (1.53 to 5.42) for patients receiving aspirin + clopidogrel. There was no statistically significant increase in patients taking either aspirin or clopidogrel alone. This study did not include direct oral anticoagulants.

Source
Prevalence of Intracranial Injury in Adult Patients With Blunt Head Trauma With and Without Anticoagulant or Antiplatelet Use.  Ann Emerg Med. 2020 Mar;75(3):354-364. doi: 10.1016/j.annemergmed.2019.10.004. Epub 2020 Jan 17.

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