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

[so_real]

I feel that. Having people tell you to take a drug or risk dying, while you are actually dying on the emergency room bed, is a level of pressure few can withstand. And in a case like this where the drug was unnecessary and likely contributing to the life threatening emergency, it's downright cruel. I suspect the nurses were sincere; they only know what they were taught and some of them are called to the job for having genuine compassion and empathy. You can't hate people trying to do their best for you, but it sure hurts when they are wrong. But the doctors and nurses who know it is wrong, but do it anyway because "that's the job" and because "the pay is good" are evil.

[sauropod]

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