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Updated: Oct 9, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Acute haemorrhage rate in 28,000 Out-of-Hours CT heads
Katherine C Hocking1, Catriona R Wright1, Utku Alhun1
1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Insights
The rate of intracranial hemorrhage (ICH) on CT head scans remained steady despite increased demand. Patients on direct oral anticoagulants (DOACs) showed a lower ICH incidence compared to warfarin users and the general population.
Area of Science:
- Neuroradiology
- Emergency Medicine
- Pharmacology
Background:
- CT head imaging demand has significantly increased over 12 years, particularly for out-of-hours investigations.
- Intracranial hemorrhage (ICH) rates have remained stable in recent years, justifying the rise in imaging.
- Anticoagulant use, including warfarin and direct oral anticoagulants (DOACs), is common in patients undergoing CT head scans.
Purpose of the Study:
- To assess the acute hemorrhage rate in patients undergoing CT head investigations.
- To compare hemorrhage rates between patients with and without trauma.
- To compare hemorrhage rates between patients on warfarin and DOACs.
Main Methods:
- Retrospective analysis of CT head scans performed between 2008 and 2019 at Sheffield Teaching Hospitals.
- Identification of scans with available requesting information from 2015 onwards.
- Clinical information assessed for trauma or anticoagulation; reports categorized into acute and non-acute findings.
Main Results:
- CT head scans increased by 63% from 2008-2019, with out-of-hours scans rising by 278%.
- Acute ICH incidence averaged 6.9% between 2015-2019.
- Hemorrhage detection was lower in anticoagulated patients: warfarin (5.2%) and DOACs (2.8%) compared to non-anticoagulated (6.8%).
Conclusions:
- Despite increased CT head demand, ICH rates are stable, validating the need for imaging.
- Patients prescribed DOACs exhibit a lower incidence of ICH compared to warfarin users and the general population.
- Findings suggest a need to discuss DOAC bleeding risks in relation to CT head imaging guidelines.
Objectives:
The aim of this paper is to assess the acute haemorrhage rate in patients who had CT head investigation out-of-hours with and without trauma and compare the rates of haemorrhage between warfarin and DOACs, at a busy teritary teaching hospital.
Methods:
All CT heads performed between January 2008 and December 2019 were identified from the radiology information system (RIS) at Sheffield Teaching Hospitals (STH), with the requesting information being available from January 2015. The clinical information was assessed for the mention of trauma or anticoagulation, and the reports were categorised into acute and non-acute findings.
Results:
Between 2008 and 2019 the number of scans increased by 63%, with scans performed out of hours increasing by 278%. Between 2015 and 2019, the incidence of acute ICH was similar over the 5-year period, averaging at 6.9% and ranging from 6.1 to 7.6%. The rate of detection of acute haemorrhage following trauma was greater in those not anticoagulated (6.8%), compared with patients on anticoagulants such as warfarin (5.2%) or DOACs (2.8%).
Conclusions:
Over 12 years, there has been a significant increase in the number of CT heads performed at STH. The rate of ICH has remained steady over the last 5 years indicating a justified increase in imaging demand. However, the incidence of ICH in patients prescribed DOACs is lower than the general population and those on warfarin.
Advances In Knowledge:
This finding in a large centre should prompt discussion of the risk of bleeding with DOACs in relation to CT head imaging guidelines.
