Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study

Capsoni, Nicolò; Carpani, Giovanni; Tarantino, Francesca; Gheda, Silvia; Cugnod, Jean Marc; Lanfranchi, Sabrina; Lee, Jhe; Lizza, Simone; Marchesani, Sara; Meloni, Enrica; Rigamonti, Annalisa; Serrai, Irene; Vergani, Silvia; Zuddio, Elisa Ginevra; Zumbo, Bruno Gherardo; PRIVITERA, Daniele; Salinaro, Francesco; Bernasconi, Davide; Secco, Gianmarco; Galbiati, Filippo; Perlini, Stefano; Bombelli, Michele

doi:10.1186/s13049-025-01337-y

Article (Scientific journals)

Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study

Capsoni, Nicolò; Carpani, Giovanni; Tarantino, Francesca et al.

2025 • In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33 (1)

Peer Reviewed verified by ORBi

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https://hdl.handle.net/10993/66520

DOI
10.1186/s13049-025-01337-y

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39930444

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Keywords :

Anticoagulants; Brain injuries; Cerebral hemorrhage; Emergency department; Aged; Aged, 80 and over; Brain Concussion; Emergency Service, Hospital; Female; Humans; Incidence; Intracranial Hemorrhages; Italy; Male; Retrospective Studies; Risk Factors; Time Factors; Tomography, X-Ray Computed; anticoagulant agent; aged; brain concussion; brain hemorrhage; clinical trial; complication; epidemiology; etiology; female; hospital emergency service; human; incidence; male; multicenter study; procedures; retrospective study; risk factor; time factor; very elderly; x-ray computed tomography

Abstract :

[en] Background: Anticoagulated patients with mild traumatic brain injury (mTBI) and a negative cerebral CT on admission, commonly undergo a repeated CT scan after observation in the emergency department (ED) to detect delayed intracranial hemorrhage (ICH). However, the utility of this practice is controversial, with recent evidence suggesting that the risk of delayed ICH in these patients is low. This study aims to evaluate incidence, outcomes, and risk factors of delayed ICH in patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) presenting to the ED with mTBI. Methods: A multicenter, observational, retrospective cohort study was conducted in the EDs of three hospitals in Northern Italy, from January 2017 to December 2021. All consecutive adult patients on DOACs or VKAs therapy, admitted for a mTBI, who underwent a second CT scan after 12–24 h from a negative first one, were enrolled. Results: A total of 1596 anticoagulated patients were enrolled, 869 (54%) on DOACs and 727 (46%) on VKAs therapy. The median age was 84 [79–88] and 56% of patients were females. The incidence of delayed ICH was 1.8% (95% CI: 1.1-3.0%; 14/869 patients) for DOACs, and 2.6% (95% CI: 1.6–4.1%; 19/727 patients) for VKAs patients, with no cases requiring neurosurgical intervention. Vomiting after head injury and the onset of new symptoms during observation were associated with a higher risk of delayed bleeding (OR 4.8; 95% CI: 1.4–16.5, and OR 4.7; 95% CI 1.2–23.7, respectively). At a 30-day follow-up, 2% of patients had a new ED admission related to their previous mTBI, with no significant difference between the groups. Conclusions: Delayed ICH is uncommon among anticoagulated patients with mTBI and has minimal impact on their outcome. Routine performance of a second CT scan may be unnecessary and may be considered only in presence of high-risk clinical risk factors or signs of deterioration. © The Author(s) 2025.

Disciplines :

General & internal medicine

Author, co-author :

Capsoni, Nicolò; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy ; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Carpani, Giovanni; Internal Medicine, Pio XI Hospital, ASST Brianza, Desio, Italy

Tarantino, Francesca; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

Gheda, Silvia; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Cugnod, Jean Marc; Department of Internal Medicine, University of Pavia, Pavia, Italy ; Emergency Medicine Unit, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy

Lanfranchi, Sabrina; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

Lee, Jhe; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

Lizza, Simone; Department of Internal Medicine, University of Pavia, Pavia, Italy ; Emergency Medicine Unit, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy

Marchesani, Sara; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

Meloni, Enrica; Department of Internal Medicine, University of Pavia, Pavia, Italy ; Emergency Medicine Unit, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy

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Language :

English

Title :

Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study

Publication date :

2025

Journal title :

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

eISSN :

1757-7241

Publisher :

BioMed Central Ltd

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Peer Reviewed verified by ORBi

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