Delayed Brain Bleeds in Head Trauma Rare With Anticoagulants

TOPLINE:

Delayed intracranial hemorrhage (ICH) occurred in 2% of patients with mild traumatic brain injury and a negative initial CT who were receiving anticoagulant therapy, a study found.

METHODOLOGY:

• Researchers conducted a retrospective study of 596 patients (median age, 83 years; 46.5% men) who were receiving anticoagulant therapy and presented with mild traumatic brain injury (Glasgow Coma Scale score, ≥ 13) and a negative initial CT.
• Atrial fibrillation was the most frequent indication for anticoagulant therapy (84.4%), followed by deep vein thrombosis/pulmonary embolism (9.6%); 74.5% of patients were on direct oral anticoagulants (53.4% received a reduced dosage), and 25.5% were treated with vitamin K antagonists.
• Patients underwent a second CT scan after 24 hours of observation.
• The primary outcome was the incidence of delayed ICH, and secondary outcomes included the need for neurosurgical interventions and 30-day mortality.

TAKEAWAY:

• Delayed ICH occurred in 2% of patients, with subarachnoid hemorrhage and subdural hematoma being the most common findings (five patients each).
• None of the patients with delayed ICH required neurosurgical intervention or died within 30 days.
• Patients with delayed ICH had higher rates of high-energy trauma (17% vs 1.7%; P = .044) than those with a negative second CT scan. Delayed ICH was more frequent in those receiving vitamin K antagonists than in those on direct oral anticoagulants, although the difference was not significant.
• Among patients with delayed ICH, 66% experienced complications during hospitalization, mainly nosocomial infections and delirium.

IN PRACTICE:

“[The low incidence of delayed ICH suggests that patients with minor traumatic brain injury and normal initial CT imaging] may be safely discharged without extended hospital observation, provided they have no additional risk factors,” the authors wrote.

SOURCE:

This study was led by Jacopo Davide Giamello, Santa Croce e Carle Hospital, Cuneo, Italy. It was published online on June 11, 2025, in Injury.

LIMITATIONS:

This study had a retrospective, single-center design, and its findings may have been affected by misclassification bias. Data on long-term outcomes and medication adherence or anticoagulation intensity over time were missing.

DISCLOSURES:

This study did not receive any external funding. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.