Older emergency department head trauma patients appear to have a very low incidence of delayed intracranial hemorrhage (ICH) after head injury, with no difference in rates based on prior anticoagulant use, according to a study published online June 13 in The Journal of Emergency Medicine.

Richard D. Shih, M.D., from Florida Atlantic University in Boca Raton, and colleagues examined the incidence of delayed ICH in geriatric emergency department head trauma patients prescribed anticoagulants preinjury in a prospective cohort study conducted at two hospital emergency departments. The incidence of delayed ICH, defined as an initial negative head computed tomography scan, followed by subsequent ICH believed to be caused by the initial event, was examined; the rate was compared between patient cohorts based on anticoagulant use.

Of the 3,425 patients enrolled, 67.2 percent were not on an anticoagulant, 7 percent were on preinjury warfarin, 22.7 percent were on a direct acting oral anticoagulant, and 2.8 percent were on enoxaparin or heparin. The researchers found that 6.7 percent of the participants had an acute ICH, and 0.4 percent had a delayed ICH. The rates of delayed ICH did not significantly differ between those who had versus had not been prescribed anticoagulants.

“Given the infrequency of delayed ICH, little current information exists regarding risk factors for the development of delayed ICH, an important question for future research,” the authors write.

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