Clinical Rounds

April 2012 
Volume 42  Number 4
Pages 19 - 21
  PDF Version Available!

Based on new study results, researchers recommend that patients taking warfarin who experience a minor head injury should have two computed tomography (CT) scans 24 hours apart to assess for delayed intracranial hemorrhage. These patients should also undergo 24 hours of observation.The study involved 87 patients who had minor head injuries while taking warfarin, an anticoagulant. Their initial CT scans revealed no intracranial lesions, but CT scans performed 24 hours later revealed new hemorrhage in five (6%) of the patients. One of these patients required a craniotomy. The risk of delayed bleeding was particularly high in patients whose initial international normalized ratio was greater than 3.0. Researchers concluded that "for patients receiving warfarin who experience minor head injury and have a negative initial head CT scan result, a protocol of 24-hour observation followed by a second CT scan will identify most occurrences of delayed bleeding."Source: Menditto VG, Lucci M, Polonara S, Pomponio G, Gabrielli A. Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol. Ann Emerg Med. 2012 [Epub ahead of print].Nurses who work with antineoplastic drugs or sterilizing agents are twice as likely to have a spontaneous abortion than nurses who aren't frequently exposed to these agents, according to a new study. Researchers surveyed almost 7,500 nurses who'd been pregnant between 1993 and 2002. Data were collected on self-reported occupational exposure to antineoplastic drugs, anesthetic gases, antiviral drugs, sterilizing agents, and X-rays.In all, nurses reported 6,707 live births and 775 (10%) spontaneous abortions occurring by week 20 of the pregnancy, which is similar to rates in the general population. However, exposure to antineoplastic drugs was strongly associated with early miscarriages, particularly those occurring before the 12th week of pregnancy. Exposure to these drugs carried

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