UMEM Educational Pearls

Category: Trauma

Title: Are anti-coagulated elderly head injured patients at risk for delayed intracranial hemorrhage?

Keywords: head injury, anticoagulation, delayed, intracranial, warfarin, DOAC, risk (PubMed Search)

Posted: 2/18/2023 by Robert Flint, MD (Emailed: 2/19/2023) (Updated: 6/14/2024)
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This study looked at 69,321 head injured patients over age 65 in a health care database for delayed intracranial hemorrhage (within 90 days of visit). 58,233 patients were not on oral anticoagulants, 3081 (4.4%) were on warfarin and 8007 (11.6%) were on direct oral anticoagulants. One percent of patients not on anticoagulation and those on oral direct anticoagulation had a delayed hemorrhage while those on warfarin had a 1.8% delayed hemorrhage rate.


Bottom Line: Direct oral anticoagulants do not increase the risk of delayed intracranial hemorrhage in patients over age 65 from baseline but warfarin does. 


Sharon Liu et al Delayed intracranial hemorrhage after head injury among elderly patients on anticoagulation seen in the emergency department CJEM 2022 Dec:24(8):853-861 doi:10.1007/s43678-022-00392-z.