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The following is a summary of “Low Incidence of Delayed Intracranial Hemorrhage in Geriatric Emergency Department Patients on Preinjury Anticoagulation Presenting with Blunt Head Trauma,” published in the December 2024 issue of Emergency Medicine by Shih et al. 

The incidence and management of delayed intracranial hemorrhage (ICH) in older adults (OAs) who experience head injuries while on anticoagulants remain controversial, with reported rates varying widely. 

Researchers conducted a retrospective study to determine the incidence of delayed ICH in OAs Emergency Department (ED) head trauma on preinjury anticoagulants.  

They enrolled individuals aged 65 years or older with acute head injury across 2 hospital EDs from August 2019 to July 2020. Follow-up was conducted by telephone at 14 and 60 days and through chart review at 90 days. The primary outcome was the incidence of delayed ICH, defined as an initial negative head computed tomography scan followed by subsequent ICH linked to the initial trauma. Rates of delayed ICH were compared between groups based on preinjury anticoagulant use.  

The results showed 3,425 individuals were enrolled, including 2300 (67.2%) without anticoagulants, 249 (7%) on preinjury warfarin, 780 (22.7%) on direct-acting oral anticoagulants, and 96 (2.8%) on enoxaparin or heparin. The median age was 82 years (interquartile range 65–107), with 55.2% female and 84.3% Caucasian. Acute ICH occurred in 229 of 3425 (6.7%, 95% confidence interval (CI) 6–8%), and delayed ICH was identified in 13 (0.4%, 95% CI 0.2–0.6%). No significant difference was found in delayed ICH rates between those on and without anticoagulants. (P = 0.45).  

Investigators concluded the incidence of delayed ICH was very low in OAs prescribed pre-injury anticoagulants. 

Source: sciencedirect.com/science/article/abs/pii/S0736467924001884