Study refutes blood thinner brain bleed risk after falls in older adults (Warfarin)

Medical Xpress / Florida Atlantic University / The American Journal of Emergency Medicine ^ | July 29, 2025 | Chelsea Caplan et al

[ConservativeMind]

As people age, rates of cardiovascular and cerebrovascular diseases rise, leading to more use of blood thinners such as warfarin.

Falls are the leading cause of injury and death in older adults.

While anticoagulants protect against heart and vessel problems, they increase the risk of serious bleeding, particularly, brain hemorrhages after head trauma. Current guidelines call for extra monitoring and repeat brain scans for patients on warfarin after head injuries.

Warfarin is considered especially challenging because maintaining safe blood-thinning levels—measured by the International Normalized Ratio (INR)—can be difficult. When INR is too high, bleeding risk rises significantly.

Researchers conducted a study to determine whether very high INR levels increase the risk of brain bleeding following a fall-related head injury in adults aged 65 and older who take warfarin. Conducted over one year at two Level I trauma centers in South Florida, the study examined 2,686 patients admitted to the emergency department due to a fall.

Results of the study found that being on warfarin, even at higher blood-thinning levels, did not significantly increase the risk of brain bleeding after blunt head trauma. In fact, patients with poorly controlled, low warfarin activity had the highest bleeding risk. This challenges common assumptions and underscores the importance of proper anticoagulation management rather than avoiding anticoagulants altogether.

Overall, about 11% of the patients studied experienced brain bleeding after head trauma. Among those not on blood thinners, about 6% had brain bleeds, compared to around 7% of patients on warfarin. Bleeding rates were similar between patients with INR levels above and below 3.0.

Notably, patients with lower-than-recommended INR levels had the highest rates of brain bleeding—nearly 20%. Those within or slightly above the therapeutic range had lower rates, and no brain bleeds occurred in patients with critically high INR levels (above 5).

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TOPICS: Health/Medicine
KEYWORDS: bleed; blood; brain; iwbg; warfarin

[ConservativeMind]

Amazingly, not having high levels of warfarin in patients already given warfarin prescriptions for cardio issues appeared to be responsible for higher rates of brain bleeding (20% worse).

High warfarin levels were effectively no more risky for brain bleeds after falls than those of us not on warfarin.

This is strange and counterintuitive. I will say warfarin is a medicine that conflicts with vitamin K use, but can be properly balanced, if discussed with your doctor.

[ConservativeMind]

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[aquila48]

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[srmanuel]

When I had open heart surgery to replace my aortic valve, I was given the choice of a mechanical valve or a pig biological valve, the reason I chose the pig valve was I didn’t want to have to take warfarin or Coumadin every day for the rest of my life

[gitmo]

Types of Blood Thinners

1. Anticoagulants

These slow down the clotting process by targeting clotting factors like thrombin, fibrin, and vitamin K.

- Warfarin (Coumadin, Jantoven) – Vitamin K antagonist
- Heparin – Injectable; works on thrombin and factor Xa
- Enoxaparin (Lovenox) – Low molecular weight heparin
- Apixaban (Eliquis) – Factor Xa inhibitor
- Rivaroxaban (Xarelto) – Factor Xa inhibitor
- Edoxaban (Savaysa) – Factor Xa inhibitor
- Dabigatran (Pradaxa) – Direct thrombin inhibitor

2. Antiplatelet Drugs

These prevent platelets from clumping together, which helps prevent clot formation.

- Aspirin – Common over-the-counter option
- Clopidogrel (Plavix) – Often used after heart attacks or stents
- Prasugrel (Effient) – Stronger than clopidogrel
- Ticagrelor (Brilinta) – Fast-acting platelet inhibitor
- Dipyridamole (Persantine) – Often combined with aspirin

[aquila48]

I take eliquis and a couple weeks ago my right hand went completely numb for about 5 minutes. Went to ER, did a CT scan and discovered that I had bleeding in my brain. They asked me if I had hit my had on something, and there was nothing I remembered that I would call trauma.

They checked me in and did a procedure called Middle Meningeal Artery (MMA) embolization to prevent future bleeding and took me off eliquis until further notice.

[sauropod]

Bkmk

[so_real]

Eliquis was recommended for a family member of mine following AFIB diagnosis. In the months that followed once she started taking it, we witnessed her physically deteriorate (weakness, tiredness, loss of mental acuity) while her AFIB continued unabated. We didn't know what was causing the decline, the AFIB or the Eliquis.

She ended up in the emergency room with cardiac distress and stopped the Eliquis while there (after withstanding the full-court press by doctors and nurses who were positively certain she should continue using it). She hasn't used it since, and she hasn't been to the emergency room since.

And, sidebar of interest, by faithfully adding nutritional supplements to her diet (DHEA, D-Ribose, D3+K2, Aceytyl-L-Carnitine, L-Taurine, Ubiquinol. L-Arginine, Red Yeast Rice, Garlic, Curcumin, and Nattokinase --- quite a list but easy to take) over time her episodes of AFIB have decreased substantially. She's had about 5 minutes of AFIB recorded in the last five months. And, also interesting, she has over that time eliminated one of her blood pressure medicines and cut the second one down by more than half. She is still a bit cautious, but starting to feel like she has control over her life again. It's amazing what can be accomplished when turning away from pharmaceuticals and toward nutrition.

[HerrBlucher]

I have been on eliquis for 4 years after an ischemic stroke, and have not had any problems with it. But i go out of my way not to do activities that have any kind of risk of Injury. In other words life is not nearly as much fun, but it is still better than being paralyzed in a hospital bed.

[thinden]

Bttt

[Jane Long]

A lot of these nutritional supplements can also be purchased in powder form (at places like BulkSupplements.com) to make it easier to take in a smoothie, etc.

That’s what we do with several of the daily supplements we take ... bilberry, taurine, etc.

Good for your relative to have finally gotten off of Eliquis and to have found non-toxic alternatives.

[Ruy Dias de Bivar]

I have been on warfarin since 1990 when I had a mitral valve replaced with a mechanical one. In 2006 I had a stent put in my heart and they increased my warfarin level to between INR 3 and 4. I go in for an INR check monthly when my level is OK, weekly if the INR is over or under the 3-4 level,
I have discovered I no longer have any headaches, not even hangovers. I dare not take aspirin as it increases the INR level. I cannot shoot a bolt action hunting rifle or 12 gauge shotgun as it leaves a huge bruise on my shoulder. Small injections sometimes will give a small bruise around the injection spot.
I no longer juggle chain saws for a living. ;-)

[Karoo]

I’ve been on Eliquis, low dose bid, ever since I had two DVTs. Genetic testing showed I have thick blood

No problems with the Eliquis but I do take many supplements. FYI many many supplements thin the blood.

[so_real]

re: BulkSupplements.com -- thank you for the tip!

[Colorado Doug]

I did not see Eliquis on your list. Eliquis is a Factor Xa inhibitor, meaning it blocks an enzyme (Factor Xa) involved in the blood clotting process, specifically in the production of thrombin, a key component in clot formation.

[fella]

What about the latest fad blood thinner Eliquis?

[fella]

". . . stopped the Eliquis while there (after withstanding the full-court press by doctors and nurses who were positively certain she should continue using it . . ."

I'm sure this has nothing to do with Pfizer's full-court press of advertising for Eliquis in all media, and possibly a kickback scheme for each prescription written. Cause it ain't cheap.

[MayflowerMadam]

I’ve been on Eliquis for that long, too, and it’ll be “life-long”, per my doctor. A large DVT in my thigh probably due to hip replacement surgery.

I feel great — except when I pay for it. 🫤 They told me that if anything causes me to bleed, even small cuts, it’ll be extremely dangerous. Major scare factor! I haven’t had any problems and don’t bleed excessively.

[MayflowerMadam]

Eliquis was supposed to go generic in January 2023. Humana even had me scheduled to receive the generic that month. A couple days before the release date, Pfizer pulled it. (Guess they didn’t make enough money during Covid.) The generic has existed for a long time, they just won’t let you have it.

Then they said for sure if would be in 2026.

Now I notice that April 1,2028, is the next target date. 😡🤬

[kawhill]

I chew up an 81mg baby aspirin every morning. It works, if I nick myself, I bleed.