Mild Head Trauma: Study Reveals Risks of Delayed Brain Bleeds
A recent study reveals that some individuals with mild traumatic brain injuries, who initially show no bleeding on a CT scan, might experience delayed intracranial hemorrhage if they take blood thinners. This finding underscores the importance of monitoring these patients closely.
Study Findings
Researchers examined 596 patients with mild traumatic brain injuries. These patients were also receiving anticoagulant therapy and initially presented with a negative CT scan. The median age of the participants was 83 years old; 46.5% were men. Atrial fibrillation was the most prevalent reason for anticoagulant use, and 74.5% of patients were on direct oral anticoagulants.
The primary goal was to determine the incidence of delayed intracranial hemorrhage (ICH). Secondary outcomes included the need for neurosurgical interventions and 30-day mortality. After 24 hours, all patients underwent a second CT scan. This follow-up was crucial in identifying delayed bleeds.
Delayed ICH developed in 2% of the patients, with subarachnoid hemorrhage and subdural hematoma being the most prevalent findings, occurring in five patients each. None of the individuals with delayed ICH needed neurosurgical intervention or died within a month.
“The low incidence of delayed ICH suggests that patients with minor traumatic brain injury and normal initial CT imaging may be safely discharged without extended hospital observation, provided they have no additional risk factors,”
— The Authors
Patients with delayed ICH were more likely to have experienced high-energy trauma. Additionally, there was a trend, though not statistically significant, toward a higher frequency of delayed ICH in those taking vitamin K antagonists compared to those on direct oral anticoagulants. According to the Centers for Disease Control and Prevention, around 2.8 million traumatic brain injury-related emergency department visits occurred in 2021 in the United States alone. (CDC 2021)
Important Considerations
During hospitalization, 66% of patients with delayed ICH experienced complications, including infections and delirium. The study, led by Jacopo Davide Giamello, was published in Injury on June 11, 2025.
The research had limitations, being a retrospective study from a single center, which could introduce bias. Information about long-term outcomes and medication adherence was not available. However, the data provides important insights into managing patients with mild head injuries who are on blood thinners.
