Reassessing the risk of hemorrhage progression in mild traumatic brain injury: the role of anticoagulant and…

Cohort studyJournal of neurosurgery· Jul 2026

Reassessing the risk of hemorrhage progression in mild traumatic brain injury: the role of anticoagulant and antiplatelet therapy.

Tessa A Harland, Gregory Topp, Tarun Prabhala … Pouya Entezami

Venous ThromboembolismCohort studyClinical practiceQ1IF 3.4

Among blood thinners, only warfarin was linked to more hemorrhage progression after mild brain injury.

Reassessing the risk of hemorrhage progression in mild traumatic brain injury: the role of anticoagulant and antiplatelet therapy.

Tessa A Harland … Pouya Entezami

Journal of neurosurgery · Jul 2026

Purpose

The aim of this study was to evaluate whether blood thinners independently increase the risk of hemorrhage progression, surgical intervention, or mortality in mild TBI with intracranial hemorrhage, and whether risk varies by specific blood thinners agent.

Methods

Were categorized by mBIG criteria and then reclassified using hemorrhage characteristics (reclassified mBIG [RmBIG]), excluding blood thinners status.

n = 2312 adult

OR 1.93

Results

OR 1.93

warfarin, unlike other blood thinners, raised the odds of bleeding worsening

n = 2312 adult

More results

Radiographic progression occurred in 14.1% of mBIG 3 patients versus 1.7% and 6.8% of mBIG 1 and 2 patients, respectively.

Among reclassified patients, those receiving blood thinners had similar progression rates to non-blood thinners patients within the same RmBIG category.

More results

Patients classified as mBIG 3 based only on blood thinners use had significantly lower progression rates (11.9%) compared with those classified based on hemorrhage severity (18.1%, p < 0.001).

Mortality and surgical intervention rates did not differ overall by blood thinners status.

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Conclusion · 1 of 2

Anticoagulant and antiplatelet therapy might not warrant automatic classification of all patients with mild TBI as high risk. While warfarin represents the upper end of the risk spectrum, most agents did not increase adverse outcomes.

Conclusion · 2 of 2

Refining Brain Injury Guidelines to incorporate hemorrhage features and agent-specific risk might improve patient care and resource utilization.

Reassessing the risk of hemorrhage progression in mild traumatic brain injury: the role of anticoagulant and antiplatelet therapy.

Reassessing the risk of hemorrhage progression in mild traumatic brain injury: the role of anticoagulant and antiplatelet therapy.

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