Assess ABCDE and neurological status first; focal deficit, seizure, suspected skull fracture, persistent GCS abnormality or repeated vomiting are urgent CT indications on their own.
For head injury with no other CT indication but anticoagulant therapy (warfarin, DOAC, heparin/LMWH) or antiplatelet therapy other than aspirin alone, NICE says consider CT within 8 hours of injury, or within 1 hour if presentation occurs more than 8 hours after injury.
Do not equate a minor mechanism with negligible risk in an older person; assess supervision, cognition, symptoms, reliable return and safeguarding before discharge.
If intracranial bleeding is suspected or confirmed, contact senior ED/stroke/neurosurgical/haematology colleagues immediately for patient-specific anticoagulant reversal.

UK sources (checked 4 Nov 2026): NICE NG232: head injury

Clinical safety: educational editorial draft, not an authorised NHS prescribing order. Clinical/pharmacy sign-off pending. Check local policies, BNF/BNFC, up-to-date guidance and individual patient factors before any treatment.

⚠️ 🧠 Head injury and anticoagulation

TIME-SENSITIVE — assess severity and escalate if deteriorating.

🔎 Recognise

Assess GCS, focal deficit, vomiting, seizure, skull fracture signs and anticoagulants.

🛟 First actions

Immediate C-spine and ABC priorities, CT according to NICE head injury pathway.

🧪 Investigate / reassess

Document observation frequency and return precautions.

⚠️ Escalation / pitfalls

Do not dismiss apparently minor head injury in anticoagulated patient.

Source: NICE NG232 head injury. Checked: 3 November 2026 for linked source; the entire topic has not undergone independent clinical sign-off. Follow your trust guidelines and senior advice. Not a standalone treatment protocol.

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Head injury and anticoagulation ⚠️ 🧠

NICE NG232: CT decisions in adults taking antithrombotics

⚠️ 🧠 Head injury and anticoagulation

🔎 Recognise

🛟 First actions

🧪 Investigate / reassess

⚠️ Escalation / pitfalls

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