{"id":756,"date":"2026-02-24T15:40:56","date_gmt":"2026-02-24T12:40:56","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=756"},"modified":"2026-02-24T15:40:57","modified_gmt":"2026-02-24T12:40:57","slug":"antikoagulan-kullanan-yaslilarda-kafa-travmasi-acil-serviste-izlem-ve-guvenli-taburculuk-stratejileri","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/antikoagulan-kullanan-yaslilarda-kafa-travmasi-acil-serviste-izlem-ve-guvenli-taburculuk-stratejileri\/","title":{"rendered":"Antikoag\u00fclan Kullanan Ya\u015fl\u0131larda Kafa Travmas\u0131: Acil Serviste \u0130zlem Ve G\u00fcvenli Taburculuk Stratejileri"},"content":{"rendered":"\n<p><strong>Yazar:<\/strong> Dr. \u00d6\u011fr. \u00dcyesi \u00d6zge CAN  <strong>Edit\u00f6r:<\/strong> Do\u00e7.Dr. Canan AKMAN<\/p>\n\n\n\n<p>Ya\u015fam s\u00fcresinin uzamas\u0131yla birlikte \u226565 ya\u015f n\u00fcfus belirgin bi\u00e7imde artm\u0131\u015f; buna paralel olarak atriyal fibrilasyon (AF), ven\u00f6z tromboemboli ve inme gibi tromboembolik hastal\u0131klar\u0131n prevalans\u0131 y\u00fckselmi\u015f ve ya\u015fl\u0131 pop\u00fclasyonda antikoag\u00fclan kullan\u0131m\u0131 yayg\u0131nla\u015fm\u0131\u015ft\u0131r. D\u00fc\u015fmeye yatk\u0131n olan bu grupta, olu\u015fan min\u00f6r kafa travmalar\u0131 bile intrakraniyal kanama (\u0130KK) a\u00e7\u0131s\u0131ndan klinik \u00f6nem ta\u015f\u0131maktad\u0131r. \u00c7ok merkezli \u00e7al\u0131\u015fmalar, antikoag\u00fclan kullanan ya\u015fl\u0131 travma olgular\u0131nda \u0130KK insidans\u0131n\u0131n daha y\u00fcksek oldu\u011funu, \u00f6zellikle vitamin K antagonisti kullananlarda riskin daha belirgin oldu\u011funu g\u00f6stermektedir. Direkt etkili oral antikoag\u00fclan (DOAK) kullan\u0131m\u0131n\u0131n art\u0131\u015f\u0131 ile \u0130KK riskinde azalma bildirilmi\u015f olsa da, t\u00fcm ajanlar\u0131 kapsayan evrensel ve kolay eri\u015filebilir bir geri \u00e7evirme stratejisinin s\u0131n\u0131rl\u0131 olmas\u0131 kanama varl\u0131\u011f\u0131nda k\u0131s\u0131tl\u0131l\u0131k olu\u015fturmaktad\u0131r. Bu nedenle hafif travmatik beyin hasar\u0131nda (hTBH) durumunda beyin bilgisayarl\u0131 tomografi (BT) s\u0131kl\u0131kla tercih edilmekte ve olgunun y\u00f6netimi daha dikkatli planlanmaktad\u0131r. Ancak ba\u015flang\u0131\u00e7 g\u00f6r\u00fcnt\u00fclemesi normal olsa bile TBH\u2019da gecikmi\u015f intrakraniyal kanama (g\u0130KK) geli\u015febilmesi olas\u0131l\u0131\u011f\u0131, karar s\u00fcrecinin en kritik noktalar\u0131ndan birini olu\u015fturmaktad\u0131r. Orta ve ciddi kafa travmas\u0131 varl\u0131\u011f\u0131nda hastan\u0131n g\u00f6r\u00fcnt\u00fcleme ve y\u00f6netimi nettir. Ancak hafif kafa travmas\u0131 varl\u0131\u011f\u0131ndaki y\u00f6netimin s\u0131n\u0131rl\u0131l\u0131klar\u0131 konunun devam\u0131nda klinik sorular ile giderilmeye \u00e7al\u0131\u015f\u0131lacakt\u0131r. \u00d6ncelikle hTBH y\u00f6netiminde risk olu\u015fturan g\u0130KK anlat\u0131lacakt\u0131r.<\/p>\n\n\n\n<p><strong>Gecikmi\u015f \u0130ntrakraniyal Kanama (g\u0130KK)<\/strong><\/p>\n\n\n\n<p>Gecikmi\u015f intrakraniyal kanama (g\u0130KK), ba\u015flang\u0131\u00e7 \u00e7ekilen beyin bilgisayarl\u0131 tomografi (BT)\u2019nin normal oldu\u011fu bir hastada, izleyen saatler veya g\u00fcnler i\u00e7inde yap\u0131lan kontrol g\u00f6r\u00fcnt\u00fclemede kanama saptanmas\u0131 olarak tan\u0131mlanmaktad\u0131r. Antikoag\u00fclan kullanan ya\u015fl\u0131 grubunda, &nbsp;hTBH sonras\u0131 g\u0130KK riski d\u00fc\u015f\u00fck olmakla birlikte tamamen s\u0131f\u0131r de\u011fildir. Bu durum g\u00f6zlem s\u00fcresi, tekrar beyin BT gereksinimi ve hasta\/hasta yak\u0131n\u0131 bilgilendirmesinin kapsam\u0131 a\u00e7\u0131s\u0131ndan klinik karar verme s\u00fcrecini do\u011frudan etkilemektedir. Geni\u015f kohort \u00e7al\u0131\u015fmalar\u0131nda, ba\u015flang\u0131\u00e7 beyin BT g\u00f6r\u00fcnt\u00fclemesi negatif olan, &nbsp;antikoag\u00fclan kullanan hTBH hastalar\u0131nda, g\u0130KK oran\u0131 yakla\u015f\u0131k %1\u20133 olarak bildirilmektedir. DOAK kullananlarda oran %1.5\u20131.8, vitamin K antagonisti (VKA) kullananlarda ise %0.6\u20134.5\u2019dir. \u00c7al\u0131\u015fmalarda g\u0130KK geli\u015fen hastalarda 30 g\u00fcn i\u00e7inde n\u00f6ro\u015fir\u00fcrjikal m\u00fcdahale ya da mortalite bildirilmemi\u015ftir. Meta-analizler ve VKA a\u011f\u0131rl\u0131kl\u0131 eski veriler de benzer \u015fekilde d\u00fc\u015f\u00fck oranlar (yakla\u015f\u0131k %0.6\u20132) ve \u00e7ok d\u00fc\u015f\u00fck cerrahi\/mortalite riski (\u2248%0\u20130.3) g\u00f6stermektedir. Genel min\u00f6r kafa travmas\u0131 pop\u00fclasyonunda g\u0130KK oran\u0131 daha da d\u00fc\u015f\u00fckt\u00fcr (~%0.3\u20130.4) ve bu hastalar\u0131n yaln\u0131zca %2\u20133\u2019\u00fcnde cerrahi gereksinim olu\u015fmaktad\u0131r.<\/p>\n\n\n\n<p>Antikoag\u00fclan kullanan hTBH hastalar\u0131nda g\u0130KK a\u00e7\u0131s\u0131ndan daha y\u00fcksek riskle ili\u015fkilendirilen klinik \u00f6zellikler :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Travma sonras\u0131 kusma<\/li>\n\n\n\n<li>Yeni veya k\u00f6t\u00fcle\u015fen n\u00f6rolojik semptomlar<\/li>\n\n\n\n<li>Bilin\u00e7 kayb\u0131<\/li>\n\n\n\n<li>Posttravmatik amnezi<\/li>\n\n\n\n<li>Y\u00fcksek enerjili travma<\/li>\n\n\n\n<li>GKS &lt;15<\/li>\n<\/ul>\n\n\n\n<p>\u0130zlem alt\u0131nda yap\u0131lan kohort \u00e7al\u0131\u015fmalar\u0131nda, &nbsp;g\u0130KK olgular\u0131n\u0131n b\u00fcy\u00fck k\u0131sm\u0131 ilk 24\u201348 saat i\u00e7inde saptanm\u0131\u015ft\u0131r. Geni\u015f analizler ise vakalar\u0131n %80\u2019den fazlas\u0131n\u0131n ilk 7 g\u00fcn i\u00e7inde ortaya \u00e7\u0131kt\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. Daha ge\u00e7 d\u00f6nem ba\u015fvurular nadir olmakla birlikte literat\u00fcrde haftalar sonra geli\u015fen ve a\u011f\u0131r seyreden olgular bildirilmi\u015ftir.<\/p>\n\n\n\n<p><strong>Klinik Pratikteki Temel Sorular<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Antikoag\u00fclan kullanan ya\u015fl\u0131 hafif travmatik beyin hasar\u0131 olgular\u0131nda ilk \u00e7ekilen beyin bilgisayarl\u0131 tomografi: rutin mi, se\u00e7ici mi?<\/strong><\/li>\n<\/ol>\n\n\n\n<p><strong>Neden rutin bilgisayarl\u0131 tomografi?<\/strong><\/p>\n\n\n\n<p>Antikoag\u00fclan kullanan ya\u015fl\u0131 hTBH olgular\u0131nda ba\u015flang\u0131\u00e7 beyin BT \u00e7ekilmesi genellikle \u00f6nerilmektedir. Bunun temel nedeni, bu grupta ba\u015flang\u0131\u00e7 \u0130KK oranlar\u0131n\u0131n k\u00fc\u00e7\u00fcmsenmeyecek d\u00fczeyde (%8\u201310) olmas\u0131 ve asemptomatik kanama olas\u0131l\u0131\u011f\u0131n\u0131n varl\u0131\u011f\u0131d\u0131r. Ya\u015fl\u0131larda,&nbsp; semptomlar\u0131n silik seyretmesi ve n\u00f6rolojik de\u011ferlendirmeyi zorla\u015ft\u0131rmakta, yaln\u0131zca klinik g\u00f6zleme dayal\u0131 bir yakla\u015f\u0131m\u0131 g\u00fcvenilir olmaktan uzakla\u015ft\u0131rmaktad\u0131r. Bu nedenle \u00e7o\u011fu rehber ve g\u00fcncel \u00e7al\u0131\u015fma, antikoag\u00fclan kullanan ya\u015fl\u0131 hTBH olgular\u0131nda en az bir beyin BT \u00e7ekilmesini desteklemektedir.<\/p>\n\n\n\n<p><strong>Ne zaman se\u00e7ici yakla\u015f\u0131m?<\/strong><\/p>\n\n\n\n<p>Bununla birlikte son y\u0131llarda yay\u0131mlanan b\u00fcy\u00fck kohort \u00e7al\u0131\u015fmalar\u0131nda, antikoag\u00fclan kullan\u0131m\u0131n\u0131n tek ba\u015f\u0131na \u0130KK i\u00e7in ba\u011f\u0131ms\u0131z risk olu\u015fturmad\u0131\u011f\u0131; riskin daha \u00e7ok klinik fakt\u00f6rler (GKS &lt;15, bilin\u00e7 kayb\u0131, kusma, \u015fiddetli ba\u015f a\u011fr\u0131s\u0131, n\u00f6rolojik defisit, y\u00fcksek enerjili travma, frakt\u00fcr \u015f\u00fcphesi) ile ili\u015fkili oldu\u011fu g\u00f6sterilmi\u015ftir. Asemptomatik, n\u00f6rolojik muayenesi normal, d\u00fc\u015f\u00fck enerjili travma ge\u00e7irmi\u015f ve g\u00fcvenilir sosyal deste\u011fi olan, \u00e7ok d\u00fc\u015f\u00fck riskli olgularda yaln\u0131zca ila\u00e7 kullan\u0131m\u0131na dayanarak beyin BT \u00e7ekmenin her zaman gerekli olmayabilece\u011fi tart\u0131\u015f\u0131lmaktad\u0131r. Bu nedenle g\u00fcncel e\u011filim, ilac\u0131 direk bir tetikleyici olarak g\u00f6rmek yerine, klinik risk de\u011ferlendirmesi ve payla\u015f\u0131ml\u0131 karar verme \u00e7er\u00e7evesinde bireyselle\u015ftirilmi\u015f yakla\u015f\u0131m geli\u015ftirmektir.<\/p>\n\n\n\n<p>Sonu\u00e7 olarak, antikoag\u00fclan kullanan ya\u015fl\u0131 olgularda, &nbsp;ba\u015flang\u0131\u00e7ta beyin BT g\u00f6r\u00fcnt\u00fclemenin al\u0131nmas\u0131 \u00e7o\u011fu durumda g\u00fcvenli ve rasyonel bir yakla\u015f\u0131md\u0131r ancak \u00e7ok d\u00fc\u015f\u00fck risk ta\u015f\u0131yan olgularda dikkatli klinik de\u011ferlendirme ile daha se\u00e7ici stratejiler, gelecekte daha fazla yer bulabilir. Gelecekte sa\u011fl\u0131kl\u0131 ya\u015flanma kavram\u0131n\u0131n g\u00fc\u00e7lenmesi, farmakovijilans sistemlerinin geli\u015fmesi ve ya\u015fl\u0131ya \u00f6zg\u00fc risk skorlar\u0131n\u0131n olu\u015fturulmas\u0131 ile daha se\u00e7ici g\u00f6r\u00fcnt\u00fcleme stratejileri m\u00fcmk\u00fcn olabilir.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">2- <strong>Oral antikoag\u00fclan tipi, ya\u015fl\u0131 hafif travmatik beyin hasar\u0131 olgular\u0131nda gecikmi\u015f intrakraniyal kanama riskini de\u011fi\u015ftirir mi?<\/strong><\/h2>\n\n\n\n<p>Ya\u015fl\u0131 hTBH olgular\u0131nda VKA, ba\u015flang\u0131\u00e7 beyin BT\u2019de saptanan erken \u0130KK riskini DOAK\u2019lara k\u0131yasla daha fazla art\u0131rmaktad\u0131r (\u2248%10\u201316 vs %4\u20137; OR \u22480.4\u20130.6 DOAK lehine). Ancak ba\u015flang\u0131\u00e7 beyin BT\u2019si normal olan hastalarda g\u0130KK oran\u0131 hem DOAK hem de VKA kullananlarda d\u00fc\u015f\u00fck (%1\u20132) olup, n\u00f6ro\u015fir\u00fcrjikal m\u00fcdahale ve mortalite son derece nadirdir. \u00c7o\u011fu \u00e7al\u0131\u015fmada ila\u00e7 tipleri aras\u0131nda anlaml\u0131 fark g\u00f6sterilememi\u015ftir. Bu nedenle tekrar beyin BT \u00e7ekilmesi ve g\u00f6zlem karar\u0131, antikoag\u00fclan tipinden \u00e7ok klinik risk belirte\u00e7lerine (GKS &lt;15, kusma, yeni semptom vb.) dayanmal\u0131d\u0131r.<\/p>\n\n\n\n<p>3<strong>-Antikoag\u00fclan kullanan ya\u015fl\u0131 hafif travmatik beyin hasar\u0131 olgular\u0131nda gecikmi\u015f intrakraniyal kanamay\u0131 \u00f6ng\u00f6rmeye y\u00f6nelik standardize edilmi\u015f bir risk skoru mevcut mudur? <\/strong><strong><\/strong><\/p>\n\n\n\n<p>Literat\u00fcrde ya\u015f, kraniyofasiyal\/servikal yaralanma, diyabetes mellitus ve hipertansiyon gibi de\u011fi\u015fkenleri i\u00e7eren bir g\u0130KK risk arac\u0131 bildirilmi\u015f ancak bu model, &nbsp;klinik prati\u011fe yayg\u0131n \u015fekilde girmemi\u015ftir. G\u00fcncel kan\u0131tlar, \u00f6zel ve kabul edilmi\u015f bir \u201cg\u0130KK skoru\u201d bulunmad\u0131\u011f\u0131n\u0131, risk stratifikasyonunun halen standart klinik uyar\u0131 bulgular\u0131na dayand\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. Bu konu halen bir \u00e7al\u0131\u015fma konusu olarak g\u00fcncelli\u011fini korumaktad\u0131r ve gelecekte yapay zeka algoritmalar\u0131 ile desteklenen risk skorlar\u0131 m\u00fcmk\u00fcn olabilir g\u00f6r\u00fcnmektedir.<\/p>\n\n\n\n<p><strong>4-. <\/strong><strong>Antikoag\u00fclan kullanan ya\u015fl\u0131 hafif travmatik beyin hasar\u0131 olgular\u0131nda, ilk \u00e7ekilen beyin bilgisayarl\u0131 tomografi normal ise rutin kontrol beyin bilgisayarl\u0131 tomografi gerekli midir?<\/strong><strong><\/strong><\/p>\n\n\n\n<p>\u00c7al\u0131\u015fmalar\u0131n b\u00fcy\u00fck b\u00f6l\u00fcm\u00fc, n\u00f6rolojik olarak stabil seyreden ve ilk beyin BT\u2019si normal olan ya\u015fl\u0131 antikoag\u00fclan kullanan olgularda rutin 12\u201324 saatlik tekrar BT\u2019nin klinik yarar\u0131n\u0131n s\u0131n\u0131rl\u0131 oldu\u011funu g\u00f6stermektedir.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>75 ya\u015f \u00fczeri olgularda ikinci beyin BT\u2019nin, \u00e7ekilmi\u015f olan ilk beyin BT tetkiki negatif ve klinik stabilitesi mevcutsa gereksiz oldu\u011fu bildirilmi\u015ftir.<\/li>\n\n\n\n<li>\u00c7ok merkezli hTBH kohortlar\u0131nda rutin 12\u201324 saatlik tekrar beyin BT \u00e7ekilmesinden ka\u00e7\u0131n\u0131labilece\u011fi, yaln\u0131zca y\u00fcksek riskli \u00f6zellikler veya klinik k\u00f6t\u00fcle\u015fme varl\u0131\u011f\u0131nda yap\u0131lmas\u0131 bu g\u00f6r\u00fcnt\u00fcleme tetkikinin yap\u0131lmas\u0131 gerekti\u011fi belirtilmi\u015ftir.<\/li>\n\n\n\n<li>Meta-analizler, rutin tekrar beyin BT\u2019nin d\u00fc\u015f\u00fck klinik getiri sa\u011flad\u0131\u011f\u0131n\u0131 ortaya koymaktad\u0131r.<\/li>\n<\/ul>\n\n\n\n<p>Mevcut kan\u0131tlar, ba\u015flang\u0131\u00e7 beyin BT\u2019si normal olan, klinik olarak stabil ve antikoag\u00fclan kullanan ya\u015fl\u0131 hTBH olgular\u0131nda, rutin<strong> kontrol BT\u2019nin genellikle gerekli olmad\u0131\u011f\u0131n\u0131<\/strong><strong>&nbsp;<\/strong><strong>g<\/strong>\u00f6stermektedir. Olgunun y\u00f6netimi; zorunlu tekrar g\u00f6r\u00fcnt\u00fcleme yerine dikkatli klinik izlem, hasta ve yak\u0131nlar\u0131n\u0131n bilgilendirilmesi ve risk temelli se\u00e7ici g\u00f6r\u00fcnt\u00fcleme yakla\u015f\u0131m\u0131na dayanmal\u0131d\u0131r.<\/p>\n\n\n\n<p><strong>5-Hafif travmatik beyin hasar\u0131nda optimal g\u00f6zlem s\u00fcresi ne kadar olmal\u0131d\u0131r?<\/strong><\/p>\n\n\n\n<p>Hafif travmatik beyin hasar\u0131 (hTBH),&nbsp; ba\u015flang\u0131\u00e7 beyin BT g\u00f6r\u00fcnt\u00fclemesinin normal oldu\u011fu olgularda g\u00f6zlem s\u00fcresi konusu son y\u0131llarda yeniden de\u011ferlendirilmektedir. \u00d6zellikle ya\u015fl\u0131 ve antikoag\u00fclan kullanan olgularda, &nbsp;geleneksel olarak \u00f6nerilen rutin 24 saatlik hastane g\u00f6zlemi yakla\u015f\u0131m\u0131, g\u00fcncel kan\u0131tlar \u0131\u015f\u0131\u011f\u0131nda daha se\u00e7ici ve hedeflenmi\u015f bir g\u00f6zlem stratejisine do\u011fru evrilmektedir. G\u00fcncel e\u011filim, &nbsp;k\u0131sa s\u00fcreli klinik izlem ve g\u00fc\u00e7l\u00fc taburculuk bilgilendirmesi ile g\u00fcvenli ayaktan takip y\u00f6n\u00fcndedir.<\/p>\n\n\n\n<p>B\u00fcy\u00fck \u00e7ok merkezli \u00e7al\u0131\u015fmalarda, ba\u015flang\u0131\u00e7 beyin BT\u2019si normal olan antikoag\u00fclan kullanan hTBH olgular\u0131nda ilk 24 saat i\u00e7inde semptomatik g\u0130KK oran\u0131n\u0131n son derece d\u00fc\u015f\u00fck oldu\u011fu bildirilmesine dayan\u0131larak rutin 24 saatlik yat\u0131\u015f\u0131n \u00e7o\u011fu olguda gerekli olmad\u0131\u011f\u0131 belirtilmi\u015ftir. Benzer \u015fekilde retrospektif kohort analizlerinde g\u0130KK oran\u0131 yakla\u015f\u0131k %3 civar\u0131nda bildirilmi\u015f ancak bu olgular\u0131n hi\u00e7birinde cerrahi gereksinim ya da mortalite g\u00f6zlenmemi\u015ftir. Buna kar\u015f\u0131n 24 saatlik acil servis g\u00f6zlemi s\u0131ras\u0131nda %6\u20137 oran\u0131nda ciddi iatrojenik komplikasyon geli\u015fti\u011fi rapor edilmi\u015f, rutin g\u00f6zlemin risk\u2013fayda dengesi sorgulanm\u0131\u015ft\u0131r. Sistematik derlemeler, 24 saatlik hastane g\u00f6zlemi s\u0131ras\u0131nda saptanan g\u0130KK\u2019\u0131n son derece nadir ve \u00e7o\u011funlukla klinik olarak \u00f6nemsiz oldu\u011funu g\u00f6stermektedir. Ba\u015flang\u0131\u00e7 beyin BT\u2019si normal, GKS 15, n\u00f6rolojik muayenesi stabil ve g\u00fcvenilir sosyal deste\u011fi olan ya\u015fl\u0131 antikoag\u00fclan kullanan olgularda rutin 24 saatlik hastane yat\u0131\u015f\u0131n\u0131n kan\u0131t temeli zay\u0131ft\u0131r. Bu grupta, &nbsp;k\u0131sa s\u00fcreli g\u00f6zlem, klinik tablonun yeniden de\u011ferlendirilmesi ve ayr\u0131nt\u0131l\u0131 yaz\u0131l\u0131\u2013s\u00f6zl\u00fc taburculuk e\u011fitimi \u00e7o\u011fu zaman yeterli g\u00f6r\u00fcnmektedir. Optimal yakla\u015f\u0131m; klinik k\u00f6t\u00fcle\u015fme bulgular\u0131na duyarl\u0131, ancak gereksiz yat\u0131\u015f ve iatrojenik risklerden ka\u00e7\u0131nan, bireyselle\u015ftirilmi\u015f bir g\u00f6zlem stratejisidir (Tablo 1).<\/p>\n\n\n\n<p><strong>Tablo1 Klinik bulgulara g\u00f6re g\u00f6zlem \u00f6nerileri<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><div class=\"pcrstb-wrap\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Klinik Senaryo<\/strong> <strong>(hTBI, BT Normal)<\/strong><\/td><td><strong>\u00d6nerilen G\u00f6zlem Stratejisi<\/strong><\/td><\/tr><tr><td><strong>&nbsp;<\/strong> <strong>Antikoag\u00fclan kullanan, GKS 15, klinik stabil, g\u00fcvenilir sosyal destek mevcut<\/strong><\/td><td>&nbsp; K\u0131sa s\u00fcreli acil servis g\u00f6zlemi (yakla\u015f\u0131k 4\u20136 saat), ayr\u0131nt\u0131l\u0131 bilgilendirme ile taburculuk &nbsp;<\/td><\/tr><tr><td><strong>&nbsp;<\/strong> <strong>Antikoag\u00fclan kullanan ve y\u00fcksek risk \u00f6zellikleri bulunan (kusma, yeni\/k\u00f6t\u00fcle\u015fen semptom, GKS &lt; 15, y\u00fcksek enerjili travma, k\u0131r\u0131lgan, yetersiz sosyal destek)<\/strong> <strong>&nbsp;<\/strong><\/td><td>&nbsp; Daha uzun s\u00fcreli g\u00f6zlem ve\/veya 12\u201324 saat i\u00e7inde tekrar beyin BT i\u00e7in; karar bireyselle\u015ftirilmelidir<\/td><\/tr><tr><td><strong>&nbsp;<\/strong> <strong>Antikoag\u00fclan kullanmayan, n\u00f6rolojik muayenesi normal<\/strong><\/td><td>&nbsp; Erken taburculuk ve ayr\u0131nt\u0131l\u0131 bilgilendirme<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n<p><strong>6-Acil servisten taburcu edilen, beyin bilgisayarl\u0131 tomografi sonucu normal olan ya\u015fl\u0131 hafif<\/strong> <strong>travmatik beyin hasar\u0131 olgular\u0131nda oral antikoag\u00fclasyon kullan\u0131m\u0131 kesilmeli midir?<\/strong><\/p>\n\n\n\n<p>G\u00fcncel acil servis derlemelerinde, hTBH sonras\u0131 oral antikoag\u00fclasyonun (OAK) s\u00fcrd\u00fcr\u00fclmesi ya da kesilmesi konusunda net bir uzla\u015f\u0131 olmad\u0131\u011f\u0131 belirtilmektedir. Bununla birlikte, gecikmi\u015f kanama riskinin d\u00fc\u015f\u00fck, tromboembolik riskin ise baz\u0131 hastalarda y\u00fcksek olabilece\u011fi g\u00f6z \u00f6n\u00fcne al\u0131narak, rutin kesme yerine bireysel risk\u2013fayda de\u011ferlendirmesi \u00f6nerilmektedir.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Baz\u0131 kurum protokollerinde, k\u0131sa s\u00fcreli hastane g\u00f6zlemi s\u0131ras\u0131nda OAK tedavisine devam edilmekte; yaln\u0131zca belirgin intrakraniyal kanama, orta\u2013a\u011f\u0131r TBH veya y\u00fcksek riskli kanama durumlar\u0131nda tedavi kesilmekte ya da geri \u00e7evirme uygulanmaktad\u0131r. Mevcut \u00e7al\u0131\u015fmalar, negatif beyin BT sonucu sonras\u0131 rutin olarak antikoag\u00fclasyonu kesmenin g\u0130KK\u2019y\u0131 azaltt\u0131\u011f\u0131na dair net bir fayda g\u00f6stermemektedir. Bildirilen ba\u015fl\u0131ca zararlar, \u00e7o\u011funlukla gereksiz g\u00f6zlem ve yat\u0131\u015fa ba\u011fl\u0131 iatrojenik komplikasyonlard\u0131r.<\/h2>\n\n\n\n<p>Ba\u015flang\u0131\u00e7 beyin BT\u2019si normal olan hTBH\u2019l\u0131 ya\u015fl\u0131 olgularda, &nbsp;g\u00fcvenli taburculuk \u00e7o\u011fu zaman m\u00fcmk\u00fcnd\u00fcr ve rutin yat\u0131\u015f ya da tekrar beyin BT \u00e7ekilmesinin gereklili\u011fi kan\u0131tlarla g\u00fc\u00e7l\u00fc bi\u00e7imde desteklenmemektedir. Benzer \u015fekilde, negatif BT sonras\u0131 OAK rutin olarak kesilmesini destekleyen net bir kan\u0131t bulunmamaktad\u0131r. Karar, &nbsp;tromboembolik endikasyonun g\u00fcc\u00fc, d\u00fc\u015fme\/kanama riski ve hastan\u0131n g\u00fcvenilir takibi dikkate al\u0131narak bireyselle\u015ftirilmelidir.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Sonu\u00e7 ve \u00d6nerilen Yakla\u015f\u0131m<\/strong><\/h2>\n\n\n\n<p>Antikoag\u00fclan kullanan, ya\u015fl\u0131 hTBH bulunan olgularda mevcut kan\u0131tlar do\u011frultusunda en rasyonel yakla\u015f\u0131m, ba\u015flang\u0131\u00e7ta t\u00fcm hastalara beyin BT \u00e7ekilmesidir. Ancak izlem ve tekrar g\u00f6r\u00fcnt\u00fcleme kararlar\u0131, &nbsp;klinik temelde bireyselle\u015ftirilmelidir. Rutin 24 saatlik g\u00f6zlem ve rutin tekrarlayan beyin BT yerine; n\u00f6rolojik durum, travma mekanizmas\u0131 ve ek risk fakt\u00f6rleri dikkate al\u0131narak se\u00e7ici bir izlem stratejisi benimsenmelidir.<\/p>\n\n\n\n<p>\u0130ntrakraniyal kanama saptand\u0131\u011f\u0131nda, \u00f6zellikle vitamin K antagonisti kullanan hastalarda uygun tedavinin gecikmeksizin uygulanmas\u0131 \u00f6nem ta\u015f\u0131r. Uzun d\u00f6nem antikoag\u00fclasyonun yeniden ba\u015flanmas\u0131 ise tromboembolik risk ile kanama y\u00fck\u00fc aras\u0131ndaki denge g\u00f6zetilerek, multidisipliner de\u011ferlendirme e\u015fli\u011finde planlanmal\u0131d\u0131r.<\/p>\n\n\n\n<p>Ayr\u0131ca hasta ve yak\u0131nlar\u0131n\u0131n g\u0130KK belirtileri konusunda ayr\u0131nt\u0131l\u0131 bi\u00e7imde bilgilendirilmesi ve net ba\u015fvuru kriterlerinin yaz\u0131l\u0131 ve s\u00f6zl\u00fc olarak verilmesi, g\u00fcvenli taburculu\u011fun temel bile\u015fenidir.<\/p>\n\n\n\n<p>Bu hasta grubunda temel hedef, &nbsp;gereksiz g\u00f6r\u00fcnt\u00fcleme ve yat\u0131\u015flardan ka\u00e7\u0131n\u0131rken klinik olarak anlaml\u0131 kanamay\u0131 atlamamak, ayn\u0131 zamanda g\u00fcvenli, rasyonel ve kaynak bilinci y\u00fcksek bir acil servis y\u00f6netimi sa\u011flamakt\u0131r.<\/p>\n\n\n\n<p>Bu konuda g\u00fcncel \u00e7al\u0131\u015fmalar\u0131n net sonu\u00e7lar ifade edememesi, halen \u00e7al\u0131\u015fma konusu olarak g\u00fcncel bir konu oldu\u011funu ve gelecekte \u00f6zellikle yapay zeka destekli uygulamalar ile yeniliklere a\u00e7\u0131k oldu\u011funu g\u00f6stermektedir.<\/p>\n\n\n\n<p>REFERANSLAR<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Capsoni N, Carpani G, Tarantino F, et al. Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study.\u00a0<em>Scand J Trauma Resusc Emerg Med.<\/em>\u00a02025;33(1):26. doi:10.1186\/s13049-025-01337-y<\/li>\n\n\n\n<li>Shih RD, Alter SM, Solano JJ, et al. Low incidence of delayed intracranial hemorrhage in geriatric emergency department patients on preinjury anticoagulation presenting with blunt head trauma.\u00a0<em>J Emerg Med.<\/em>\u00a02024;67(6):e516-e522. doi:10.1016\/j.jemermed.2024.06.002<\/li>\n\n\n\n<li>Karamian A, Seifi A, Karamian A, et al. Incidence of intracranial bleeding in mild traumatic brain injury patients taking oral anticoagulants: a systematic review and meta-analysis.\u00a0<em>J Neurol.<\/em>\u00a02024;271:3849-3868. doi:10.1007\/s00415-024-12424-y<\/li>\n\n\n\n<li>Jaffres E, Dacher JN, Taalba M, et al. Possible limited justification for systematic head computed tomography scans based solely on antithrombotic therapy in elderly patients (aged 75 or older) with mild traumatic brain injury.\u00a0<em>Res Diagn Interv Imaging.<\/em>\u00a02025;13:100053. doi:10.1016\/j.redii.2024.100053<\/li>\n\n\n\n<li>Santing JAL, Lee YX, van der Naalt J, van den Brand CL, Jellema K. Mild traumatic brain injury in elderly patients receiving direct oral anticoagulants: a systematic review and meta-analysis.\u00a0<em>J Neurotrauma.<\/em>\u00a02022;39(7-8):458-472. doi:10.1089\/neu.2021.0435<\/li>\n\n\n\n<li>Park N, Turcato G, Zaboli A, Santini M. The state of the art of the management of anticoagulated patients with mild traumatic brain injury in the emergency department.\u00a0<em>Emerg Care J.<\/em>\u00a02022;18(2):10640. doi:10.4081\/ecj.2022.10640<\/li>\n\n\n\n<li>Flaherty S, Biswas S, Watts DD, et al. Findings on repeat posttraumatic brain computed tomography scans in older patients with minimal head trauma and the impact of existing antithrombotic use.\u00a0<em>Ann Emerg Med.<\/em>\u00a02023;81(3):364-374. doi:10.1016\/j.annemergmed.2022.08.006<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Yazar: Dr. \u00d6\u011fr. \u00dcyesi \u00d6zge CAN Edit\u00f6r: Do\u00e7.Dr. Canan AKMAN Ya\u015fam s\u00fcresinin uzamas\u0131yla birlikte \u226565 ya\u015f n\u00fcfus belirgin bi\u00e7imde artm\u0131\u015f; buna paralel&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":757,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10065,10018,10024],"class_list":["post-756","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-antikoagulan","tag-geriatri","tag-kafa-travmasi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/756","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=756"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/756\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/757"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=756"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=756"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=756"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}