In this retrospective study at 103 hospitals of patients over age 65 who received a head CT:
5948 total patients
3177 (53%) were on at least one anti-thrombotic (warfarin, direct oral anticoag, or anti-platelet agent)
781 (13%) had inter cranial hemorrhage. (ICH)
No form of AC showed an increased risk of ICH.
Risk factors for ICH were: “a high-level fall, a Glasgow coma scale of 14, a cutaneous head impact , vomiting, amnesia, a suspected skull vault fracture or of facial bones fracture”
To me this really begs the question are we ordering head CTs on the right patients? Was there any indication of head injury in these patients or did the mere presence of a patient on AC prompt the imaging order? More work should be done to prevent needless imaging cost, patient time in the emergency department and radiologist work load/turn around time.
References
Benhamed A, Crombé A, Seux M, Frassin L, L'Huillier R, Mercier E, Émond M, Millon D, Desmeules F, Tazarourte K, Gorincour G. Association between antithrombotic medications and intracranial hemorrhage among older patients with mild traumatic brain injury: a multicenter cohort study. Eur J Emerg Med. 2025 Jul 1. doi: 10.1097/MEJ.0000000000001246. Epub ahead of print. PMID: 40590793.
