Management of Head Laceration in Elderly Patient on Apixaban
For a 78-year-old female on Eliquis with less than 2 cm glued lacerations following a head injury, ice can be safely applied intermittently, and prophylactic antibiotics are not recommended as they provide no benefit for clean, properly closed lacerations.
Wound Care Instructions
Icing Protocol
- Ice can be safely applied to the laceration site to reduce pain, swelling, and edema 1
- Use crushed or cubed ice with water (melting ice water) rather than ice alone
- Apply for no more than 20 minutes at a time to avoid tissue damage
- Allow skin to return to normal temperature between applications
- Alternatively, 10-minute intermittent cooling is acceptable if 20-minute applications cause discomfort 1
Wound Care
- Keep the wound clean and dry for the first 24 hours
- After 24 hours, gentle cleansing with mild soap and water is permitted
- Do not scrub the wound or disturb the tissue adhesive
- Avoid swimming or soaking the wound until the glue naturally falls off (typically 5-10 days)
- No need for additional dressings as the tissue adhesive serves as both closure and dressing
Antibiotic Recommendations
Prophylactic antibiotics are not recommended for this patient's wound for the following reasons:
- The wound is clean, small (<2 cm), and has been properly closed with tissue adhesive
- No evidence supports prophylactic antibiotics for clean, minor lacerations 1
- Antibiotics should be reserved for wounds with high infection risk (contaminated wounds, immunocompromised patients, etc.)
Anticoagulation Management
Monitoring
- No immediate adjustment of Eliquis (apixaban) is necessary for this minor head injury with no intracranial abnormality
- Continue regular apixaban dosing as prescribed
- Monitor for signs of delayed bleeding or neurological changes
Warning Signs to Report
- Instruct patient to seek immediate medical attention for:
- Increasing headache or new onset headache
- Confusion or altered mental status
- Nausea or vomiting
- Vision changes
- Increased swelling, redness, or drainage from the wound site
- Fever above 100.4°F (38°C)
Follow-up Recommendations
- Schedule follow-up in 7-10 days to assess wound healing
- No need for suture removal as tissue adhesive will naturally slough off
- Consider neurological reassessment given patient's age and anticoagulation status
Special Considerations for Patients on Apixaban
Patients on direct oral anticoagulants like apixaban require special attention after trauma:
- Higher risk of delayed bleeding compared to patients not on anticoagulation
- Tissue adhesive (glue) is an appropriate closure method for small lacerations in anticoagulated patients
- Avoid NSAIDs for pain control due to increased bleeding risk; acetaminophen is preferred
The management approach prioritizes wound healing while minimizing complications related to the patient's anticoagulation status. Close monitoring for delayed bleeding is essential, but routine care is appropriate for this minor injury with no intracranial abnormality.