Warfarin does not increase the risk of cerebral hemorrhage

Aging brings with it a remarkable increase in the incidence of cardiovascular and cerebrovascular pathologies, which makes the use of Anticoagulants, especially warfarinbe increasingly common in older people. However, this benefit entails a risk: in this same group, Falls They are frequent and can cause cranial trauma and intracranial hemorrhages.

Alone in United States, for 2021the falls were responsible for 38,000 deaths and near 3 million emergenciesconsolidating as the main cause of injury and mortality in older adults. Although anticoagulants protect against heart and vascular events, it is known that they favor the appearance of serious bleedingespecially when there is a Craneoecephalic trauma.

For years it has been assumed that a INR (standardized international index) of anticoagulants above the therapeutic range considerably increases the risk of intracranial bleeding. Therefore, the Clinical recommendations They suggest performing additional monitoring and repeating brain image studies In patients suffering from a fall. However, handling the warfarin is complex: reaching a safe balance in anticoagulation is difficult and, if the INR is too high, the fear of bleeding is increased. Even so, many of the studies that linked inr high with hemorrhages have been limited by the sample size or lack of methodological consistency.

Warfarin is not associated with a higher risk of bleeding

To examine this topic, specialists from the Faculty of Medicine Charles E. Schmidt of the Atlantic University of Florida (USA) They conducted an investigation in Two trauma centersanalyzing for a year 2,686 patients over 65 years served by falls in the emergency department. The cases of those who were already under treatment with Warfarin in front of those who did not use any anticoagulant.

The analysis, Published in the American Journal of Emergency Medicinethrew an unexpected result: Warfarin consumption, even with a high anticoagulation level, did not mean a significant increase in risk of intracranial hemorrhage after a closed cranial trauma. In fact, the researchers found that The greatest risk was given in patients with insufficient warfarin activity and poor control of your INR. This finding defies traditional assumptions and emphasizes that priority should be Maintain proper anticoagulation controland not avoid it.

In general terms, 11% of the patients included had cerebral hemorrhage After a cranial trauma. In whom They did not take anticoagulantsthe percentage was 6%while in the treaties with warfarina, it rose just to 7%. Hemorrhage rates were stable in patients with INR above or below 3. The most revealing was that those with INR lower than recommended They reached the Higher hemorrhage rate, close to 20%. In contrast, those who were located in therapeutic or slightly higher values ​​had much lower ratesand surprisingly, No intracranial hemorrhages were recorded in those who had an extremely high INR.

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Practical application for emergency medical care

“The data of our study suggest that Inr supraterapeutic levels could not increase the risk of intracranial hemorrhage as much as it was previously believed“The Dr. Richard Shihmain author of the investigation. In the words of the medical teacher, “ands fundamental reassess our approach to the management of anticoagulation in older adults“, especially in the face of hospital emergency care.

The team of researchers expect their conclusions to contribute both to Optimize clinical outcomes of older patients with trauma such as reduce medical care costs. To guarantee solidity in the results, in addition to Physical exams, clinical history, blood analysis and tomographsa telephone tracking 14 days after trauma.

The main purpose was to identify whether the intracranial hemorrhage appeared within two weeks after the eventin addition to analyzing your Type, severity and clinical evolution. As stated by the co -author Lisa Clayton, doctor in Medicine: “This research is especially valuable. I could help emergency teams to make smart and balanced decisions“