ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2021
Intracranial hemorrhage after head injury among older patients on anticoagulation seen in the emergency department: a population-based cohort study.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed, 31 citations in OpenAlex.
- Retrospective Review of Head Injury: Are Pre-Injury Anticoagulant and Antiplatelet Therapy Associated with Acute Traumatic Intracranial Hemorrhage?Diagnostics (Basel, Switzerland) · 2026Article
- Idarucizumab Reversal in Subdural Hemorrhage: A Single-Center Experience.Life (Basel, Switzerland) · 2025Article
- Just the facts: head injury following ground-level falls in older patients-to scan or not to scan?CJEM · 2024Article
- Overuse of CT for Minor Head Trauma Patients: A Retrospective Analysis from Poland and Lithuania Trauma Centres.Medicina (Kaunas, Lithuania) · 2024Article
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- Risk of both intracranial hemorrhage and ischemic stroke in elderly individuals with nonvalvular atrial fibrillation taking direct oral anticoagulants compared with warfarin: Analysis of the ANAFIE registry.International journal of stroke : official journal of the International Stroke Society · 2023Article
- Does a fall from a standing height warrant computed tomography in an elderly patient with polytrauma?World journal of emergency medicine · 2023Article
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- Outdated criteria for drug plan reimbursement obstruct evidence-based care.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2021Article
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8 authors at 4 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundIntracranial hemorrhage (ICH) after head injury is a concern among older adult patients on anticoagulation. We evaluated the risk of ICH after an emergency department visit for head injury among patients 65 years and older taking warfarin or a direct oral anticoagulant (DOAC) compared with patients not taking anticoagulants. We also evaluated risk of 30-day mortality and neurosurgical intervention among patients with ICH.
methodsIn this retrospective cohort study, we used population-based data of patients 65 years and older seen in an Ontario emergency department with a head injury. We matched patients on the propensity score to create 3 pairwise-matched cohorts based on anticoagulation status (warfarin v. DOAC, warfarin v. no anticoagulant, DOAC v. no anticoagulant). For each cohort, we calculated the relative risk of ICH at the index emergency department visit and 30-day mortality. We also calculated the hazard of neurosurgical intervention among patients with ICH.
resultsWe identified 77 834 patients with head injury, including 64 917 (83.4%) who were not on anticoagulation, 9214 (11.8%) who were on DOACs and 3703 (4.8%) who were on warfarin. Of these, 5.9% of patients had ICH at the index emergency department visit. Patients on warfarin had an increased risk of ICH compared with matched patients on DOACs (relative risk [RR] 1.43, 95% confidence interval [CI] 1.20-1.69) and patients not on anticoagulation (RR 1.36, 95% CI 1.15-1.61). We did not observe a difference in ICH between patients on DOACs compared with matched patients not on anticoagulation. In patients with ICH, 30-day mortality did not differ by anticoagulation status or type. Patients on warfarin had an increased hazard of neurosurgery compared with patients not on anticoagulation.
interpretationPatients on warfarin seen in the emergency department with a head injury had higher relative risks of ICH than matched patients on a DOAC and patients not on anticoagulation, respectively. The risk of ICH for patients on a DOAC was not significantly different compared with no anticoagulation. Further research should confirm that older adults using warfarin are the only group at higher risk of ICH after head injury.
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