EP 401 Optimising the Haemostasis of Patients with Intracranial Haemorrhage

Aim

Optimising the haemostasis of patients admitted with intracranial haemorrhage (ICH) to a District General Hospital.

Methodology

This retrospective quality improvement project included patients admitted with ICH under the general surgical team over a six-month period (01/01/2025-01/07/2025). Data was collected from the electronic health record (Cerner) and outcomes were analysed. Data will be presented as median (range) unless stated otherwise. Statistical analysis conducted on GraphPad Prism.

Results

73 patients were included, age 79(18-99) years. Thirty-four patients (47%) had a Clinical Frailty Score (CFS) >4. 99% of patients (n=72) were discussed with the neurosurgery centre, eighteen required re-discussion, and three were transferred. No patients required ICU admission.

Twenty-eight patients (38.9%) were anticoagulated, predominantly on direct oral anticoagulants (n=24, 85.7%): twenty-three (82%) had atrial fibrillation, two had venous thromboembolism, two had metallic heart valves. The average length of stay (LOS) of patients on anticoagulation was 10 (1-39) days compared to 6 (1-30) days in the non-anticoagulated group, this was statistically significant (p=0.02). Eight patients were discussed with haematology. Twenty patients received Beriplex for reversal, seven had Vitamin K. Five patients had Tranexamic acid. Eight patients had haemorrhagic progression on repeat CT, five had been on anticoagulants.

Of the five patients who died, four had been on anticoagulation, which was reversed. The deceased patients were 84 (95-77) years old with a CFS of 4.

Conclusion

Frail patients with complex co-morbidities including those on anticoagulation experienced longer LOS and higher mortality rates. Establishing a ‘Head injury pathway’ will optimise patient care.