Inappropriate Use of Anticoagulants and Antiplatelets in Intracranial Hemorrhage Patients: A Retrospective Study From a Tertiary Referral Level 1 Trauma Center

BACKGROUND AND OBJECTIVES: Intracranial hemorrhage (ICH) is a known risk factor associated with the use of oral anticoagulants (ACs) and antiplatelets (APs). Guidelines regarding the initiation and continuation of both ACs and APs are heterogeneous and complex. The management of these drugs in the setting of ICH is a frequent problem encountered by neurosurgeons today. The objective of this study was to determine the proportion of appropriate and inappropriate use of ACs or APs before ICH based on current guidelines. The secondary objective was to identify specific patient subpopulations that are at higher risk for unindicated AC or AP use before ICH. METHODS: All ICH diagnoses at a tertiary trauma hospital from 2020 to 2022 were retrospectively reviewed for premorbid AC/AP use, defined as any AC/AP use occurring within 7 days before diagnosis. Demographics, hemorrhage characteristics, length of stay, and mortality data were collected. To determine appropriateness of medication use, the authors referenced all relevant clinical guidelines. RESULTS: Of 2662 ICH diagnoses, 424 (15.9%) met inclusion criteria. AC or AP use was deemed inappropriate in 129 (30.4%) encounters, among which improper indication (58%) was the leading cause for inappropriate use. No significant differences based on age, sex, race, or insurance were found when comparing appropriate vs inappropriate AC/AP use. CONCLUSION: This study demonstrates that more than 30% of patients taking AC/APs before ICH were doing so inappropriately, mostly due to indications that fell outside current clinical guidelines. Neurosurgical providers should be aware of which ICH patients are most likely to be taking unindicated AC/APs-namely, aspirin 81 mg for primary prevention or dual antiplatelet therapy for secondary prevention-and collaborate with other providers to reduce unnecessary risk in this patient population.