Antithrombotic therapy does not cause intracranial hemorrhage after falls, CT scans show

Patients who take antithrombotic medications are not at an increased risk of traumatic intracranial hemorrhage after minor head injuries, experts reported in the American Journal of Roentgenology

Scientists recently reviewed the CT brain scans of more than 1,600 individuals to evaluate how such medications impacted brain bleeds when minor head trauma is sustained after ground-level falls. Minor head trauma was not associated with increased incidence of traumatic intracranial hemorrhage (tICH); however, the images did reveal associations between the medications and hematoma expansion. 

“Ground-level fall is traditionally considered to represent low-energy trauma that is potentially associated with minor head trauma,” first author Zeynep Vardar, MD, at the University of Massachusetts Medical Center in Worcester, and co-authors wrote. “However, minor head trauma may lead to substantial head injuries in patients on antithrombotic therapy, for example causing traumatic intracranial hemorrhage (tICH) by either direct impact or indirect force.” 

Many patients who routinely take antithrombotic medications are elderly and at an increased risk of falls. Consequently, this also makes them more susceptible to tICH. Noncontrast CT is widely used to evaluate  tICH but in patients on antithrombotic therapy who present with trauma, imaging recommendations vary. Some experts suggest avoiding imaging unless patients experience loss of consciousness, while others refer to CT scans regardless of neurological status. 

Since specific imaging guidelines for this cohort of patients are lacking, researchers sought to determine the frequency, distribution, and clinical course of tICH in patients with good neurological status after sustaining a ground-level fall. They examined a total of 1,630 patients who underwent head CTs in the emergency department after having a fall. In the patients with observed tICH, initial CT scans were compared to follow-up exams (within 24 hours) were analyzed for hematoma expansion, and a comparison between patients on antithrombotic therapy were then compared to those who were not. 

The researchers did not note a significant difference of tICH incidence for patients taking antithrombotic medications compared to those who weren’t (4.4% vs 3.1%, respectively), but there was a substantial difference in hematoma expansion between the two groups (26.2% vs 4.8%). Neurosurgical intervention was required for two patients, and three died within 30 days of tICH related causes, each of whom were on antithrombotic therapy. 
 
“While early follow-up head CT should be routinely performed in patients on antithrombotic therapy with tICH, systematic early imaging follow-up may not be required in patients with tICH not on antithrombotic therapy,” the authors suggested. 

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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.

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