EP 438 Anticoagulation or Antiplatelet Therapy Recommencement in Traumatic Brain Injury Patients

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ID: 323911
2026
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Abstract
Abstract Objectives Over the years, number of patients sustaining traumatic intracranial haemorrhage (tICH) while on anticoagulant or antiplatelet therapy has increased significantly, but guidance on safe recommencement remains limited. This review aims to synthesise current evidence on the timing, safety, and outcomes of antithrombotic therapy recommencement after tICH. Methods We conducted a literature review of observational studies reporting outcomes after recommencement of antithrombotic therapy in tICH patients. In studies involving both traumatic and spontaneous ICH, we specifically excluded data of sICH. Data collected are traumatic brain injury (TBI) severity, haemorrhage subtype, antithrombotic class, timing of recommencement, rebleeding, and thromboembolic events. Results Six retrospective observational studies (n=1680) with different recommencement strategies were identified. Mild TBI is the most common sustained TBI severity. Where specified, subdural haematoma accounts for 84.3% of all haemorrhage subtypes. Based on included studies, antithrombotic recommencement timing can be grouped into early (median 1–7 days), intermediate (median 16–35 days), and late (median >2 months) periods. Clinically significant rebleeding was uncommon across all recommencement periods. However, thromboembolic events do increase during prolonged suspension, especially in the group taking both anticoagulation and antiplatelet therapy. Conclusion Current evidence suggests that antithrombotic therapy can be safely recommenced in selected patients with tICH, and likely earlier than sICH due to differences in pathophysiology. The ongoing RESTART-TICrH trial could potentially provide prospective guidance specifically in tICH populations. The results should be stratified by injury severity, haemorrhage subtype, and antithrombotic class, with standardised outcome reporting, to guide evidence-based practice in the near future.
Reference Key
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Authors L. Lee, Yasser Mohamed, Christie Swaminathan, Muhammad Sajid
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.591
URL
https://doi.org/10.1093/bjs/znag087.591
Keywords Keywords not found

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