The Effect of Anticoagulants and Antiplatelets on the Risk of Intracranial Hemorrhage in Mild Traumatic Brain Injury

Abstract

Background: Mild traumatic brain injury (mTBI) is one of the most common causes for seeking care in the emergency department (ED). Patients are usually the elderly who experience a low energy fall, and preexisting antithrombotic treatment in this group of patients is not uncommon. Guidelines including risk factors such as anticoagulation therapy (ACT) and antiplatelet therapy (APT) are often used to guide the decision of whether to perform head computed tomography (HCT) to detect consequences such as intracranial hemorrhage (ICH). However, previous research is not consistent with differences in bleeding risk between these two groups of medications. Aim: The aim of this study is to compare the risk of developing an ICH after mTBI in patients taking anticoagulants and antiplatelets. Material and methods: A retrospective study including adult patients (>15 years old) admitted to selected EDs in Stockholm between 2015 and 2020 due to mTBI (GCS 13-15) within 24 h of trauma and who underwent an HCT. Digital medical records were used to identify patients on ACT and APT. A total of 21,711 patients were included from 4,002 were on ACT and 3,901 on APT. Results: The incidence of ICH was 8,3% for patients with ACT and 11% for patients with APT. Patients in these drug groups were older and more often had comorbidities such as dementia. APT was shown to be a significant independent risk factor for ICH (OR 1.41, 95% CI 1.25-1.59, p=<0.001), whereas ACT was not (OR 1.12, 95% CI 0.98-1.27, p=0.088). Conclusion: According to our data, APT increases the risk of ICH in patients with mTBI, but ACT does not.