ORCID
- Ellie Edlmann: 0000-0002-7253-9115
Document Type
Article
Abstract
IntroductionTraumatic intracranial haemorrhage (tICH) commonly follows falls in elderly people, around half of whom are taking anti-thrombotic (AT) medications pre-injury. ATs are typically stopped acutely, but guidance on safe recommencement is limited.Research questionWe surveyed UK neurosurgical consultants to understand variations in AT recommencement practice and inform trial design.Materials and methodsAn online cross-sectional survey was distributed via the Society of British Neurological Surgeons mailing list to assess self-reported consultant practice regarding cessation and recommencement of AT therapy following tICH.ResultsSixty-two consultant neurosurgeons responded. Following tICH most are very likely or likely to stop AT therapy for AF (92%), stroke prevention (85-90%), or previous MI (78%). There was greater variation when managing those with cardiac stents, with only 59% stopping ATs. Recommencement typically occurred at two weeks post-injury in both conservatively (50%) and surgically (40%) managed patients, with ∼80% of neurosurgeons restarting ATs within four weeks. Most defined early AT resumption to be one-week (72%), while late resumption was more varied at four (39%) and six (31%) weeks. Willingness to randomise was highest in lower-risk cases. More caution was shown to randomising patients with cardiac indications for AT therapy, greater injury severity, and reduced consciousness.Discussion and conclusionThese findings highlight the need for better evidence and guidance in this patient group. Based on the survey findings, a trial design targeting patients on AT therapy for AF or secondary VTE prevention, randomised to early (<7 days) versus late (4 weeks) resumption appears a relevant trial question.
DOI Link
Publication Date
2026-09-06
Publication Title
Brain and Spine
Volume
6
Acceptance Date
2026-08-28
Deposit Date
2026-09-18
Funding
None
Additional Links
Keywords
Antithrombotics, Aging, Elderly, Head injury
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Read, J., Whitfield, P., Jenkinson, M., McMahon, C., & Edlmann, E. (2026) 'Recommencement of anti-thrombotics following traumatic intracranial haemorrhage; a preliminary survey of UK consultant neurosurgeons informing the RESTART-tICrH trial design', Brain and Spine, 6. Available at: 10.1016/j.bas.2026.106667
