Aspirin 81mg and Head CT Rules in the Elderly After a Fall
Yes, aspirin 81mg does count as a blood thinner with respect to head CT rules in the elderly after a fall, and should be considered a risk factor for delayed intracranial hemorrhage.
Risk Assessment for Elderly Patients on Aspirin
Aspirin, even at low doses of 81mg, inhibits the formation of thromboxane A2, a potent stimulator of platelet aggregation, and is considered an antiplatelet agent that can increase bleeding risk 1
In elderly patients who sustain a fall with head trauma, aspirin use has been associated with a 4.6% rate of traumatic intracranial hemorrhage, with 81.5% of these cases occurring in patients taking low-dose 81mg aspirin 2
While the risk of intracranial hemorrhage with aspirin may be lower than with anticoagulants, clinical guidelines still classify aspirin as a blood thinner that warrants consideration in head CT decision-making for elderly fall patients 1
Clinical Evidence on Aspirin and Intracranial Hemorrhage
A prospective study of elderly patients with mild or moderate head trauma found that 4.3% of patients on antiplatelet agents (primarily aspirin) developed traumatic intracranial hemorrhage compared to 1.7% of those on anticoagulants 2
Research has shown that elderly trauma patients on antiplatelets, including aspirin, have elevated rates of intracranial hemorrhage and poorer outcomes compared to those not on antithrombotic therapy 3
One study specifically examining low-dose aspirin found that 24.5% of elderly patients on aspirin prophylaxis who experienced mild-to-moderate head trauma had evidence of intracranial hemorrhage on CT scan 4
Head CT Decision-Making for Elderly Fall Patients
For elderly patients (≥65 years) who have fallen and are on low-dose aspirin, current clinical guidelines recommend obtaining a head CT scan to rule out intracranial hemorrhage, similar to protocols for patients on other anticoagulant or antiplatelet medications 1
The 2023 clinical policy from the American College of Emergency Physicians specifically notes that aspirin should be considered when evaluating elderly patients with mild traumatic brain injury, as it may increase the risk of delayed intracranial hemorrhage 1
One study found that 4% of elderly patients on low-dose aspirin who had a negative initial head CT after a fall developed delayed intracranial hemorrhage, with one requiring neurosurgical intervention 1
Management Considerations
While single antiplatelet use (like aspirin 81mg) may carry a lower mortality risk than dual antiplatelet therapy or anticoagulants, it still warrants initial head CT evaluation after falls in the elderly 3, 5
The FDA drug label for aspirin specifically warns about increased risk of severe stomach bleeding in patients age 60 or older who take blood thinners or steroids concurrently with aspirin 6
For elderly patients on aspirin who sustain head trauma from a fall, clear discharge instructions with return precautions are warranted due to the potential (up to approximately 5%) for delayed intracranial hemorrhage 1
Common Pitfalls to Avoid
Do not assume that low-dose aspirin (81mg) is insignificant as a blood thinner - it still affects platelet function and increases bleeding risk, particularly in elderly patients 1, 2
Avoid overlooking aspirin when applying head CT rules for elderly fall patients, as studies show it can be associated with significant rates of intracranial hemorrhage 1, 3
Do not automatically withhold aspirin after a negative head CT, as the risk of thromboembolic events may outweigh the risk of delayed bleeding in many patients with cardiovascular indications for aspirin therapy 1