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Taking blood thinners can increase the risk stroke after a head injury

"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."

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By Mark Waghorn via SWNS

Taking blood thinners can increase the risk of a stroke after a head injury, according to new research.

A study found patients on older medications including clopidogrel and warfarin were vulnerable.

Those also using aspirin were most prone to delayed intracranial hemorrhage.

"The rate 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," said lead author Dr. Warren Chang, a neuroradiologist at the Allegheny Health Network, Pennsylvania.

They boost blood flow to the heart and brain. As the population ages, the prevalence of patients taking them is rising.

Intracranial haemorrhage occurs when vessels within the brain rupture, releasing blood into the brain tissue.

Delayed bleeding in the brain occurs after the initial trauma and usually within 48 hours, after an initial negative scan.

Head injury is a known cause - along with high blood pressure and the use of blood thinners.

"The incidence of delayed post traumatic intracranial hemorrhage in patients on different types of blood thinners with and without the addition of aspirin is not well established," said Chang.

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

Adults taking blood thinners who suffer a blow to the head typically undergo CT imaging of the brain.

But the standard of care beyond that is not well defined. Some hospitals admit patients for observation and repeat scans.

Others may discharge a patient who does not have intracranial haemorrhage and is in a stable condition.

"Different hospital networks have different strategies for repeat imaging of these patients," said Chang.

The US team analyzed the records of all patients taking blood thinners who suffered head trauma and underwent CT imaging in the Allegheny Health Network between January 1, 2017, and January 1, 2020.

Patients were included in the study if initial scans were negative for intracranial hemorrhage and repeat imaging was subsequently performed.

The final group of 1,046 patients included 547 women and 499 men with an average age of 77.

More than half (576) were taking one of the newer blood thinners such as apixiban, rivaroxaban and dabigatran.

The other 470 patients were on warfarin, clopidogrel or another older medication.

Overall, 20 patients (1.91 percent) suffered a delayed hemorrhage and three (0.3 percent) died.

All deaths were among those in the warfarin/clopidogrel/older blood thinner group.

Of the 20, 15 were taking an older type of blood thinner - nine of whom were also taking aspirin.

Among the five patients taking newer blood thinners, four 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," said co-author Dr. Thomas Campbell, also of the Allegheny Health Network.

Based on the findings, the researchers recommend follow-up CT for patients taking an older blood thinner or any along with aspirin.

They say it is unnecessary for those who only take one of the newer blood thinners and do not take aspirin - unless there are external signs of trauma.

"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," said Chang.

Millions of Britons take blood thinners every day to keep them from developing dangerous blood clots.

"This study illustrates how innovative imaging can drive optimal patient care," said co-author Professor Bethany Casagranda, chair of the Imaging Institute of the Allegheny Health Network.

"In the end, I believe the recommendations of this work will save many lives."

The findings were presented at a meeting of the Radiological Society of North America in Chicago.

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