About 25% of major hemorrhages occurring in elderly patients during warfarin anticoagulation are intracranial, and most of these bleeds (about 75%) either are fatal or result in severe residual disability.1,2 In contrast, major extracranial hemorrhage uncommonly results in death or permanent disability.1 Almost 90% of deaths from warfarin sodium–associated bleeding are due to intracranial bleeding.1 The health consequences of intracranial hemorrhage are so different from those of extracranial major hemorrhage that it begs the question whether these 2 sites of bleeding should be grouped together as “major hemorrhage” when reporting the results of randomized trials of antithrombotic therapies. Intracranial hemorrhage is often the deal breaker in the benefit vs risk decision to use anticoagulation to prevent stroke in elderly patients.
Hart RG, Pogue J, Eikelboom JW. Direct-Acting Oral AnticoagulantsThe Brain Gets a Break. JAMA Neurol. 2013;70(12):1483-1484. doi:10.1001/jamaneurol.2013.4347