Study Objectives:

The incidence of delayed intracranial hemorrhage (DICH) is poorly understood in Veterans with low-risk blunt head trauma (BHT) while on pre-injury anticoagulant or antiplatelet (ACAP). The purpose of this study was to evaluate the incidence of DICH within a single urban Veterans Affairs (VA) Emergency Department (ED).

Methods:

A 30-month retrospective observational study (January 2017 – July 2019) was conducted using the VA Computerized Patient Record System. Data were collected using a standardized electronic form. Inclusion criteria consisted of patients presenting to the ED for evaluation of BHT with a negative initial head computed tomography scan (CTH) while on pre-injury ACAP. Patients with severe facial or skull fractures were excluded. Follow-up notes at least 5 days after index ED visit were reviewed for documentation of DICH. 

Results:

There were 221/1298 patients (17.0%) that met our inclusion criteria. The study population was 98% male and had a mean age of 70.5 ± 15.5 years. The most common mechanism of injury was ground-level falls (69.2%). 188 patients (85%) were on pre-injury antiplatelet (157 aspirin, 30 clopidogrel, 1 ticagelor) and 69 patients (31.2%) on pre-injury anticoagulant (29 apixaban, 21 warfarin, 9 rivaroxaban, 4 dabigatran, 4 heparin compound, 2 edoxaban). There were 51 patients (23.1%) on dual ACAP (consisting primarily of aspirin/plavix). No DICH was documented.

Conclusion:

Delayed intracranial hemorrhage is an infrequent event in Veterans with low-risk BHT while on pre-injury ACAP. Prospective analysis is needed to determine the true incidence of DICH in this patient population.