Delayed intracranial hemorrhage after head trauma seems rare and rarely needs intervention—even in antiplatelet or anticoagulation therapy

Delayed intracranial hemorrhage after head trauma seems rare and rarely needs intervention—even in antiplatelet or anticoagulation therapy

MESH, Brain injuries, Traumatic intracranial hemorrhages, Traumatic anticoagulant tomography, X-ray
computed

Background Traumatic brain injury causes morbidity, mortality, and at least 2,500,000 yearly emergency depart-
ment visits in the USA. Computerized tomography of the head is the gold standard to detect traumatic intracranial

hemorrhage. Some are not diagnosed at the first scan, and they are denoted “delayed intracranial hemorrhages. ” To
detect these delayed hemorrhages, current guidelines for head trauma recommend observation and/or rescanning

for patients on anticoagulation therapy but not for patients on antiplatelet therapy. The aim of this study was to inves-
tigate the prevalence and need for interventions of delayed intracranial hemorrhage after head trauma.

Methods The study was a retrospective review of medical records of adult patients with isolated head trauma
presenting at Helsingborg General Hospital between January 1, 2020, and December 31, 2020. Univariate statistical
analyses were performed.
Results In total, 1627 patients were included and four (0.25%, 95% confidence interval 0.06–0.60%) patients had
delayed intracranial hemorrhage. One of these patients was diagnosed within 24 h and three within 2–30 days. The
patient was diagnosed within 24 h, and one of the patients diagnosed within 2–30 days was on antiplatelet therapy.

None of these four patients was prescribed anticoagulation therapy, and no intensive care, no neurosurgical opera-
tions, or deaths were recorded.

Conclusion Traumatic delayed intracranial hemorrhage is rare and consequences mild and antiplatelet and anti-
coagulation therapy might confer similar risk. Because serious complications appear rare, observing, and/or rescan-
ning all patients with either of these medications can be debated. Risk stratification of these patients might have

the potential to identify the patients at risk while safely reducing observation times and rescanning.
Keywords MESH, Brain injuries, Traumatic intracranial hemorrhages, Traumatic anticoagulant tomography, X-ray
computed

Henrik Bergenfeldt1

, Jakob Lundager Forberg2

, Riikka Lehtinen2

, Ebba Anefjäll2 and Tomas Vedin1*

https://doi.org/10.1186/s12245-023-00530-z

2023

Peri Irawan

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