Authors say findings warrant re-examining approach to managing anticoagulation in older adults
By Lori Solomon HealthDay Reporter
TUESDAY, Aug. 5, 2025 (HealthDay News) — Having a supratherapeutic international normalized ratio (INR) while taking warfarin does not significantly increase the risk for brain bleeding after blunt head trauma in older adults, according to a study published in the October issue of the American Journal of Emergency Medicine.
Chelsea Caplan, from the University of Miami Miller School of Medicine, and colleagues assessed whether a supratherapeutic INR (INR >3.0) is associated with an increased risk for intracranial hemorrhage (ICH) in geriatric patients prescribed preinjury warfarin who presented to the emergency department following head trauma. The evaluation involved a secondary analysis of a prospective study and included 2,686 patients, of whom 2,423 were in the no-anticoagulants or antiplatelet group and 263 were in the warfarin group.
The researchers found that about 11 percent of the patients experienced brain bleeding after head trauma. Among patients not on blood thinners, about 6 percent had brain bleeds versus approximately 7 percent of patients on warfarin. For INR levels above and below 3.0, ICH rates were similar. In a post hoc analysis of ICH rates by INR, patients with subtherapeutic INR levels (INR <2.0) had the highest rates of brain bleeding — nearly 20 percent — while those within or above the therapeutic range (INR 2.0 to 4.9) had lower rates. No brain bleeds occurred in patients with critically high INR levels (INR ≥5.0).
“Data from our study suggest supratherapeutic INR levels may not increase intracranial hemorrhage risk as much as we previously believed,” senior author Richard Shih, M.D., from the Charles E. Schmidt College of Medicine at Florida Atlantic University in Boca Raton, said in a statement. “It’s critical to re-examine our approach to managing anticoagulation in older adults after head trauma to provide the safest, most effective care without unnecessary tests or hospital stays.”
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