ORCID
- Ellie Edlmann: 0000-0002-7253-9115
Document Type
Article
Abstract
Introduction: Traumatic 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 question: We surveyed UK neurosurgical consultants to understand variations in AT recommencement practice and inform trial design. Materials and methods: An 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. Results: Sixty-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 conclusion: These 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
https://doi.org/10.1016/j.bas.2026.106667, https://www.scopus.com/pages/publications/105049204802
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
