Risk of ICH from Ground-level Fall on Antiplatelets or Anticoagulants

Short Attention Span Summary

Gravity is a killer
The incidence of traumatic subarachnoid hemorrhage (tSAH) in patients with ground level fall taking either antiplatelet agents or anticoagulants was 33/939 (3.5%).  Average age was 79 years.  There was no increased risk in patients taking anticoagulants vs antiplatelet agents, which was unexpected.  No patients on direct oral anticoagulants had tICH, but there were only 31 patients on these newer agents.  This study had a fairly large number of patients, but it was probably still too small to detect meaningful differences between agents.  Rates of intracranial bleed were lower than previous studies, but the inclusion of only ground level falls vs various other mechanisms, such as direct blow or MVC, likely explains this.

Spoon Feed
Older patients taking antiplatelet agents, including aspirin 81mg, or anticoagulants have tSAH about 3.5% of the time with simple ground level fall.  REBEL EM has a great post on a similar 2012 study.

Source
Risk of Intracranial Hemorrhage in Ground Level Fall with Antiplatelet or Anticoagulant Agents.  Acad Emerg Med. 2017 May 5. doi: 10.1111/acem.13217. [Epub ahead of print]

Written by Clay Smith.  Reviewed by Thomas Davis.