Supratherapeutic warfarin and risk of intracranial hemorrhage in geriatric patients with blunt head trauma
Abstract
OBJECTIVE
The aim of our study is to assess whether a supratherapeutic international normalized ratio (INR) is associated with an increased risk of intracranial hemorrhage (ICH) in geriatric ED patients prescribed preinjury warfarin that suffer head trauma.
METHODS
This was a secondary analysis of a prospective study of geriatric head trauma patients presenting to two EDs over a one-year period. Geriatric ED patients presenting with a head injury were enrolled. Inclusion criteria were patients who sustained a ground level fall. Exclusion criteria were patients taking non-warfarin anticoagulants or patients taking antiplatelet agents not on warfarin. The primary study outcome was an ICH diagnosed on CT scan. Data included demographics, anticoagulant use, antiplatelet use, physical examination findings and head CT results. The main outcome measure was significant head injury based on therapeutic versus supratherapeutic INR.
RESULTS
Of 5776 patients identified, 2686 met inclusion criteria. There were 2423 in the No ACAP group and 263 in the warfarin. The patients in the no anticoagulants or antiplatelet group (No ACAP) were younger than the Warfarin: mean age 80.2 versus 85.3 years (p 3.0, there were no significant differences.
CONCLUSION
In older ED patients prescribed preinjury warfarin, elevated INR levels do not appear to be a risk factor for acute ICH.
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