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.