The yield of CT head scans for intracranial haemorrhage in anticoagulated patients presenting with head injury.

AIM: Anticoagulated patients presenting with head injury have previously undergone routine CT imaging, but the 2023 NICE guidelines now permit a more selective approach. Real-world data on CT yield in this cohort, particularly in the absence of other clinical risk factors, remain limited. We aim to evaluate the diagnostic yield of CT head imaging for intracranial haemorrhage (ICH) in anticoagulated patients presenting with head injury.

MATERIALS AND

METHODS

A retrospective cohort study was conducted at a large NHS Trust, identifying all CT head scans between January-March 2025 with clinical indications referencing anticoagulation. Manual review of clinical records confirmed trauma context, anticoagulant use, and presence of other NICE criteria. The primary outcome was diagnostic yield for ICH.

RESULTS

Of 746 CT head scans, 450 anticoagulated trauma cases met inclusion criteria. The overall diagnostic yield for ICH was 2.9% (n=13). Among the 360 patients imaged solely due to anticoagulation, the yield was 2.2% (n=8). Most haemorrhages were subdural haematomas (n=8), and 11 of 13 ICH cases had visible head or facial trauma. Only one patient underwent neurosurgical intervention. Compliance with NICE guideline eligibility criteria was 73%.

CONCLUSION

CT imaging in anticoagulated patients yields a low rate of ICH. Findings support a more selective and clinically integrated approach to imaging these patients, now that the updated NICE guidance allows for clinical discretion. With rising anticoagulant use in an ageing population, a move away from reflexive imaging and a more careful patient selection process is essential to ensure diagnostic value, support resource stewardship, and promote patient-centred care.