Head Injury on Anticoagulants or Antiplatelet medications : Remote Triage

Head injuries in patients taking anticoagulants (e.g., warfarin, direct oral anticoagulants [DOACs] such as apixaban or rivaroxaban) or antiplatelet agents (e.g., aspirin, clopidogrel) pose significant challenges in primary care due to the elevated risk of intracranial hemorrhage (ICH). The use of these medications is increasingly prevalent, particularly among older adults with cardiovascular conditions such as atrial fibrillation, ischemic heart disease, or prior thromboembolism. Studies indicate that anticoagulated patients face a fourfold to fivefold higher mortality risk from traumatic brain injuries compared to those not on these therapies (Pang et al., 2015). Similarly, antiplatelet therapy, often overlooked in initial triage, significantly increases the risk of ICH, with some studies reporting comparable bleeding risks to anticoagulants in the context of head trauma (van den Brand et al., 2017). This underscores the critical need for primary care clinicians to identify both anticoagulant and antiplatelet use during initial assessments to avoid missing high-risk patients.

Prompt recognition and management are essential. The National Institute for Health and Care Excellence (NICE) guidelines recommend urgent CT imaging within 1 hour for head-injured patients on anticoagulants or antiplatelets with specific risk factors, such as loss of consciousness or neurological symptoms, and a 24-hour observation period for all such...