Recommendation ID
CG176/3
Question
Antiplatelet and anticoagulant drugs:- In patients with head injury does the use of antiplatelet and anticoagulant drugs increase the risk of intracranial haemorrhage over and above factors included in the current recommendations for CT head scans?
Any explanatory notes
(if applicable)
Why this is important:- Antiplatelet and anticoagulant drugs are widely and increasingly prescribed, and many patients presenting with a head injury to the emergency department are taking these drugs. While the majority of these drugs are prescribed in older patients they are also used in younger people. This guideline provides recommendations on performing CT head scans in patients on warfarin. However, limited evidence has been identified for patients using other antiplatelet or anticoagulant drugs within studies deriving or validating clinical decision rules for determining which patients need CT head scans. There is a particular paucity of evidence in determining whether they are at increased risk of intracranial haemorrhage.
A study with appropriate economic evaluation is needed to quantify the risk of taking these drugs over and above the risk factors included in an existing clinical decision rule. Antiplatelet and anticoagulant drugs should be studied as a predictor of intracranial injury and analysed within a multivariate analysis with other predictors (including the risk factors used in this guideline to determine when a CT head scan is needed). Univariable analyses of risk of intracranial injury in groups of head injury patients who are taking these agents and those who are not, and who have no other indications for CT head scan under current guidance would also be useful.
The GDG felt that, where possible, each drug should be considered separately, particularly aspirin and clopidogrel, and that the reference standard should include CT head scan and a follow-up period of sufficient duration to capture delayed bleeding, for example, at 7 days and 1 month. Analysis would benefit from subgroup results by age (children, adults and patients over 65 years). The GDG suggested reporting similar data used in the AHEAD study.

Source guidance details

Comes from guidance
Head injury: assessment and early management
Number
CG176
Date issued
January 2014

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 28/02/2014