🩸 Delayed Bleeding

Delayed bleeding refers to hemorrhagic events that occur hours to days after the initial trauma, surgery, or vascular event, often when the patient is clinically stable or discharged.

A bleeding episode that is not present on initial imaging or physical exam, but appears after a latent period, frequently requiring repeat imaging, reintervention, or close clinical observation.

• Within 6–72 hours after:
  • Mild traumatic brain injury (especially in anticoagulated patients)
  • Cranial or spinal surgery
  • Endovascular procedures
  • Biopsies or shunt placements

• Anticoagulant or antiplatelet therapy
• Advanced age (>75 years)
• Renal failure (affects drug clearance)
• Inadequate intraoperative hemostasis
• Unrecognized vascular anomalies

• Delayed intracranial hemorrhage after a normal initial CT in mild TBI
• Epidural or subdural rebleeding after surgical evacuation
• Delayed hemorrhage in tumor bed post-craniotomy
• Spinal epidural hematoma after lumbar puncture or decompression

• Maintain high index of suspicion if symptoms recur (headache, confusion, vomiting, focal signs)
• Repeat cranial imaging (usually non-contrast CT)
• Consider ICU observation for high-risk patients even with normal initial imaging
• Surgical or endovascular intervention if mass effect or clinical deterioration

• Clearly document bleeding risk and timing of last anticoagulant dose
• Inform patients and families about symptoms of delayed bleeding
• Schedule structured follow-up or control imaging in high-risk scenarios

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• anticoagulation_reversal_protocol
• dabigatran_reversal_in_mild_traumatic_brain_injury
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