Neither the initial GCS nor INR in anticoagulated trauma patients reliably identifies patients with ICH. Rapid confirmation of ICH with expedited head CT scan combined with prompt reversal of warfarin anticoagulation with fresh frozen plasma decreases ICH progression and reduces mortality.

There is high mortality rate associated with ASA or clopidogrel or both in elderly patients who have head trauma resulting in ICH. The presenting GCS and initial grade of CT scan are most predictive of death. Progression of hemorrhage after admission is unusual. The risk of brain injury, particularly from falls, should be explained to elderly patients taking these medications.

We conclude from these data that a trauma center protocol for rapid identification of intracranial bleeding without a concomitant therapeutic protocol does not improve survival in head injured patients on preinjury warfarin.