Delayed Intracranial Hemorrhage After Blunt Head Injury With Direct Oral Anticoagulants

Area of Science:

• Emergency Medicine
• Neurology
• Radiology

Background:

• Head injuries often prompt brain CT scans, especially for patients on anticoagulants.
• Anticoagulant and antiplatelet use increases hemorrhage risk and mortality post-head injury.
• Limited data exists on delayed intracranial hemorrhage risk with Direct-Acting Oral Anticoagulants (DOACs).

Purpose of the Study:

• To estimate the risk of delayed intracranial hemorrhage in patients taking DOACs after blunt head injury.
• To evaluate the necessity of repeat CT scans in this patient population.

Main Methods:

• Retrospective chart review of patients on DOACs presenting with blunt head injury.
• Inclusion criteria: negative initial head CT, DOAC use.
• Data collected: demographics, injury details, anticoagulant/antiplatelet use.

Main Results:

• 314 patients included (rivaroxaban, apixaban, dabigatran).
• 0.95% (3/314) experienced delayed intracranial hemorrhage.
• Two of the three hemorrhages occurred in patients on concurrent antiplatelet medication.

Conclusions:

• This study is the largest to date on DOACs and delayed intracranial hemorrhage risk.
• Patients on DOACs alone (no antiplatelets) with negative initial CTs may not require admission or repeat scanning.
• Findings suggest a low risk of delayed hemorrhage in this specific patient group.