From the Guidelines
After a traumatic fall with head injury, it is recommended to wait at least 7 to 10 days before restarting blood thinners, as stated in the guidelines for the prevention of stroke in patients with stroke or transient ischemic attack 1. The decision to restart antithrombotic therapy depends on the risk of subsequent arterial or venous thromboembolism, risk of recurrent intracranial hemorrhage (ICH), and overall status of the patient. Some key factors to consider include:
- The severity of the head injury and whether there was any bleeding in the brain
- The patient's risk of blood clots, such as those with atrial fibrillation or mechanical heart valves
- The specific blood thinner being used, such as warfarin, apixaban, rivaroxaban, or dabigatran
- The results of follow-up imaging studies, such as a CT scan, to ensure there is no intracranial bleeding before restarting medications According to the guidelines, for patients with a very high risk of thromboembolism, it may be reasonable to restart warfarin therapy at 7 to 10 days after onset of the original ICH 1. However, the timing of restarting blood thinners should be individualized and determined by a healthcare provider, taking into account the patient's unique circumstances and the potential risks and benefits of antithrombotic therapy.
From the Research
Traumatic Fall and Head Injury
After a traumatic fall and hit to the head, it is crucial to consider the timing of restarting blood thinners. The decision to restart anticoagulation therapy should be made on a case-by-case basis, taking into account the individual's risk of thromboembolism and bleeding.
Considerations for Restarting Blood Thinners
- The risk of recurrent venous thromboembolism (VTE) and major bleeding should be assessed 2, 3.
- The type of anticoagulant used, such as apixaban, rivaroxaban, or warfarin, may influence the decision to restart therapy 4, 5.
- The patient's renal function, liver function, and other comorbidities should be considered when restarting anticoagulation therapy.
Timing of Restarting Blood Thinners
- There is no specific guideline on the exact timing of restarting blood thinners after a traumatic fall and head injury.
- However, studies suggest that apixaban may be a safer option compared to low-molecular-weight heparin (LMWH) or warfarin in patients with VTE and active cancer 2, 3.
- The decision to restart anticoagulation therapy should be made in consultation with a healthcare professional, taking into account the individual's specific circumstances and risk factors.
Monitoring and Follow-up
- Regular monitoring of the patient's international normalized ratio (INR) and anti-factor Xa levels may be necessary to ensure safe and effective anticoagulation therapy 4, 6.
- Close follow-up with a healthcare professional is essential to minimize the risk of complications and adjust the anticoagulation regimen as needed.