Traumatic Intracranial Hemorrhage on CT After Ground-Level Fall in Adult Patients Receiving Antithrombotic Therapy: A...

Area of Science:

• Neurology
• Emergency Medicine
• Radiology

Background:

• Antithrombotic medications are suspected to elevate the risk and severity of traumatic intracranial hemorrhage (tICH) following minor head trauma.
• Understanding the impact of these medications on tICH in patients with good neurologic status after ground-level falls is crucial for clinical decision-making.

Purpose of the Study:

• To investigate the incidence, patterns, and clinical outcomes of tICH in patients on antithrombotic therapy presenting with good neurologic status after a ground-level fall.
• To compare the characteristics and outcomes of tICH between patients receiving antithrombotic therapy and a control group.

Main Methods:

• Retrospective analysis of 1630 patients (mean age 80.2 years) who underwent head CT after a ground-level fall with Glasgow Coma Scale score ≥14 and no focal neurologic deficit.
• Patients were categorized into antithrombotic therapy (n=954) and control (n=676) groups.
• Initial and follow-up head CT scans (within 24 hours) were reviewed for tICH presence, characteristics, and hematoma expansion. Clinical outcomes were extracted from medical records.

Main Results:

• The overall incidence of tICH was 3.9%. No significant difference was found in tICH frequency between the antithrombotic (4.4%) and control (3.1%) groups.
• Hematoma expansion on follow-up CT occurred in 26.2% of the antithrombotic group versus 4.8% in the control group (p=0.04).
• All five patients requiring neurosurgical intervention or experiencing death within 30 days were on antithrombotic therapy.

Conclusions:

• Antithrombotic therapy use is not associated with an increased frequency of traumatic intracranial hemorrhage after ground-level falls in neurologically intact patients.
• However, antithrombotic therapy is associated with a significantly higher rate of hematoma expansion on follow-up imaging.
• Clinical recommendations include similar initial head CT selection criteria regardless of antithrombotic use, but systematic early follow-up CT for patients on antithrombotics with initial tICH.