Do Anticoagulants Matter After a Head Injury?

With Kerstin de Wit

Falls with a head injury are common among older adults. One of the first questions we often ask when a patient comes into the ED with a falls injury is whether the patient is anticoagulated. But how much does anticoagulation matter?

In this episode of GEMCast, Dr. Christina Shenvi sits down with Dr. Kerstin de Wit to learn how much, if at all, anticoagulation affects the risk of intracranial hemorrhage after a ground-level fall. Dr. de Wit is an Associate Professor at Queens University in Kingston, Canada, and is one of the leading experts on falls and head injuries in older adults.


Key Points

  • 20 years ago, warfarin was the main anticoagulant used. Now, more patients are taking direct oral anticoagulants (DOACs). Current research is finding that DOACs do not increase the risk of intracranial bleeding after a minor head injury or fall compared to patients who are not taking anticoagulant medication.
  • Risk for intracranial bleeding is associated with risk factors such as age, frailty, loss of consciousness, vomiting, amnesia, seizures, new neuro deficit, etc.
  • If a patient is over 65, has fallen, and has hit their head they are at high enough risk of an intracranial bleed to need a head CT scan.
  • Delayed intracranial bleeding is very rare, occurring less than 1% of the time.
  • Pay attention to antiplatelet medications – some studies suggest that being on antiplatelet medication might increase the risk of bleeding with a head injury.


  • Intracranial hemorrhage after head injury among older patients on anticoagulation seen in the emergency department: a population based cohort study: CMAJ 2021 October 12;193:E1561-7. doi: 10.1503/cmaj.210811 – View Article
  • Risk of intracranial hemorrhage between different direct oral anticoagulants in older patients seen in the emergency department with a head injury: A population-based cohort study. Volume 214, 2022. Pages 47-52. ISSN 0049-3848, – View Article
  • de Wit K, Parpia S, Varner C, et al. Clinical predictors of intracranial bleeding in older adults who have fallen: a cohort study. J Am Geriatr Soc 2020;68:970–6. doi:10.1111/jgs.16338  – View Article
  • Minhas H, Welsher A, Turcotte M, Eventov M, Mason S, Nishijima D.K. et al.
    Incidence of intracranial bleeding in anticoagulated patients with minor head injury: a systematic review and meta-analysis of prospective studies. Br J Haematol. 2018; 183: 119-126 – View Article
  • The Incidence of Traumatic Intracranial Hemorrhage in Head-Injured Older Adults Transported by EMS with and without Anticoagulant or Antiplatelet Use. 2018. Journal of Neurotrauma. Page 750-759. Volume 35. 10.1089/neu.2017.5232
    29108469. – View Article

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