HomeLifestyleHealth & FitnessPopular blood-thinners may increase risk of brain bleeding, death after head injury

Popular blood-thinners may increase risk of brain bleeding, death after head injury

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According to a new study being published today at the Radiological Society of North America’s annual meeting, the risk of delayed intracranial hemorrhage and death following head trauma was significantly higher for adults taking older blood thinning medications such as clopidogrel (Plavix) and warfarin (Coumadin) over a three-year period.

When you take aspirin with a blood thinner, you run the risk of a delayed hemorrhage.

Intracranial bleeding occurs when blood arteries in the brain burst, allowing blood to leak into the brain tissue. A delayed traumatic intracranial hemorrhage develops after the original trauma, typically within 48 hours of a negative head CT.

Intracranial bleeding is known to occur as a result of high blood pressure, head injury, and the use of blood thinners. As the population ages, the use of blood thinners becomes more prevalent.

“The incidence of delayed posttraumatic intracranial hemorrhage in patients on different types of blood thinners with and without the addition of aspirin is not well established,” says Dr. Warren Chang, a neuroradiologist and director of research at the Imaging Institute of the Allegheny Health Network in Pennsylvania.

“This is an active area of investigation, especially as novel blood thinners become more widely adopted.”

Adults who are on blood thinners and sustain head trauma typically undergo brain CT imaging. However, after initial imaging, the standard of treatment is not well defined. Certain hospitals will admit patients for observation and repeat CT imaging, while others will discharge patients who do not have intracranial hemorrhage and are in stable condition.

“Different hospital networks have different strategies for repeat imaging of these patients,” says Dr. Chang.

Between January 1, 2017, and January 1, 2020, researchers evaluated the records of all patients on blood thinners who sustained head trauma and underwent CT imaging at Allegheny Health Network. Patients were included in the research if initial CT imaging revealed no intracranial hemorrhage and later imaging revealed hemorrhage. The final study group of 1,046 patients included of 547 women and 499 males averaging 77.5 years of age.

Within the trial group, 576 patients used one of the newer blood thinners, such as apixiban (Eliquis), rivaroxaban (Xarelto), or dabigatran (Pradaxa), while 470 individuals took warfarin, clopidogrel, or another older medicine.

Overall, there was a 1.91 percent incidence of delayed bleeding (20 patients) and a 0.3 percent mortality rate (3 patients). All of the study’s deaths occurred among participants using warfarin/clopidogrel/an older blood thinner.

345 participants in the entire trial group were taking both blood thinners and aspirin. Of the 20 patients who experienced a delayed hemorrhage, 15 were on an older type of blood thinner and nine were also on aspirin.

“The rate of delayed hemorrhage was higher in patients taking older blood thinners compared to novel drugs, and significantly higher in patients taking aspirin in addition to the older medications,” adds Dr. Chang.

Four of the five individuals who developed a delayed hemorrhage while taking new blood thinners were also taking aspirin.

“Given the high volume of our trauma patients taking aspirin and anticoagulants, this study will help to guide our care of closed head injury patients in emergency medicine and support efforts to use imaging resources appropriately,” says Thomas Campbell, M.D., M.P.H., the system chair for Emergency Medicine of the Allegheny Health Network.

According to the study’s findings, the authors recommend follow-up CT for patients who did not experience initial intracranial hemorrhage from head trauma and are currently taking one of the older blood thinners, as well as for patients who are currently taking any blood thinner in combination with aspirin. Unless there are outward symptoms of trauma, a follow-up CT is not essential in individuals who are solely using one of the newer blood thinners and not aspirin.

“Taking any blood thinner concurrently with aspirin significantly increased the risk of delayed hemorrhage, while taking one of the novel medications without aspirin significantly reduced the risk,” concludes Dr. Chang.

Source: RSNA.org/press21 – RADIOLOGICAL SOCIETY OF NORTH AMERICA

Image Credit: iStock

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