Am J Emerg Med

Supratherapeutic warfarin not associated with higher ICH risk in older adults with head trauma

August 8, 2025

Study details: This secondary analysis evaluated geriatric patients (mean age 85.3 years in the warfarin group) presenting to two EDs after ground-level falls. Patients on non-warfarin anticoagulants or antiplatelet agents were excluded. The primary outcome was acute intracranial hemorrhage (ICH) on CT, comparing those with therapeutic vs. supratherapeutic INR (>3.0).

Results: Among 2,686 included patients (263 on warfarin, 2,423 with no anticoagulant/antiplatelet use), there was no significant difference in ICH rates between patients on warfarin with supratherapeutic INR and those not on anticoagulants or antiplatelets. The warfarin group was older and had a lower proportion of females compared with the control group.

Clinical impact: In geriatric patients with blunt head trauma, a supratherapeutic INR due to warfarin doesn't confer additional risk of acute ICH compared with those not on anticoagulation. This challenges the assumption that higher INR levels in this context are associated with greater hemorrhagic risk, and may inform risk stratification and management decisions in the emergency setting.

Source:

Caplan C, et al. (2025, June 14). Am J Emerg Med. Supratherapeutic warfarin and risk of intracranial hemorrhage in geriatric patients with blunt head trauma. https://pubmed.ncbi.nlm.nih.gov/40540788/