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Anticoagulant-associated traumatic subdural haematoma — RCPSC EM MCQ

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ModerateTraumaAnticoagulant-associated traumatic subdural haematomaRCPSC EM

A 78-year-old on apixaban falls and strikes his head. He is initially lucid but becomes confused in the ED. CT head shows a 9 mm acute subdural haematoma with 6 mm midline shift. Last apixaban dose was four hours ago. What is the most likely diagnosis?

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Correct answer: A — Traumatic intracranial haemorrhage with mass effect while anticoagulated

Neurological deterioration, CT-confirmed subdural haematoma and midline shift in an anticoagulated patient require neurosurgical consultation, reversal strategy and critical care-level monitoring.

Reference: Canadian neurosurgical trauma practice; ATLS; Thrombosis Canada anticoagulant reversal guidance