{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T10:40:38Z","timestamp":1780569638702,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,6,5]],"date-time":"2017-06-05T00:00:00Z","timestamp":1496620800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Anticoagulant and antiplatelet medications are known to increase the risk and severity of traumatic intracranial hemorrhage (<jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content>), even with minor head trauma. Most studies on bleeding propensity with head trauma are retrospective, are based on trauma registries, or include heterogeneous mechanisms of injury. The goal of this study was to determine the rate of <jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content> from only a common low\u2010acuity mechanism of injury, that of a ground\u2010level fall, in patients taking one or more of the following antiplatelet or anticoagulant medications: aspirin, warfarin, prasugrel, ticagrelor, dabigatran, rivaroxaban, apixaban, or enoxaparin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective cohort study conducted at a Level\u00a0I tertiary care trauma center of consecutive patients meeting the inclusion criteria of a ground\u2010level fall with head trauma as affirmed by the treating clinician, a computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) head obtained, and taking and one of the above antiplatelet or anticoagulants. Patients were identified prospectively through electronic screening with confirmatory chart review. Emergency department charts were abstracted without subsequent knowledge of the hospital course. Patients transferred with a known abnormal <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> head were excluded. Primary outcome was rate of <jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content> on initial <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> head. Rates with 95% confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>s) were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over 30 months, we enrolled 939 subjects. The mean\u00a0\u00b1\u00a0<jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> age was 78.3\u00a0\u00b1\u00a011.9 years and 44.6% were male. There were a total of 33 patients with <jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content> (3.5%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 2.5%\u20134.9%). Antiplatelets had a rate of <jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content> of 4.3% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 3.0%\u20136.2%) compared to anticoagulants with a rate of 1.7% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 0.4%\u20134.5%). Aspirin without other agents had an <jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content> rate of 4.6% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 3.2%\u20136.6%); of these, 81.5% were taking low\u2010dose 81 mg aspirin. Two patients received a craniotomy (one taking aspirin, one taking warfarin). There were four deaths (three taking aspirin, one taking warfarin). Most (72.7%) subjects with <jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content> were discharged home or to a rehabilitation facility. There were no <jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content> in 31 subjects taking a direct oral anticoagulant. <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>s were overlapping for the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is a low incidence of clinically significant <jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content> with a ground\u2010level fall in head trauma in patients taking an anticoagulant or antiplatelet medication. There was no statistical difference in rate of <jats:styled-content style=\"fixed-case\">tICH<\/jats:styled-content> between antiplatelet and anticoagulants, which is unanticipated and counterintuitive as most literature and teaching suggests a higher rate with anticoagulants. A larger data set is needed to determine if small differences between the groups exist.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13217","type":"journal-article","created":{"date-parts":[[2017,5,5]],"date-time":"2017-05-05T13:17:19Z","timestamp":1493990239000},"page":"1258-1266","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["Risk of Intracranial Hemorrhage in Ground\u2010level Fall With Antiplatelet or Anticoagulant Agents"],"prefix":"10.1111","volume":"24","author":[{"given":"Michael","family":"Ganetsky","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Lopez","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston 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