Risk of traumatic intracranial haemorrhage is increased in older people exposed to oral anticoagulation with phenprocoumon

  • G. Büchele
  • K. Rapp
  • J.M. Bauer
  • A. Jaensch
  • C. Becker
  • Petra BenzingerEmail author
Original Article



Hospital admissions resulting from traumatic intracranial haemorrhages (TIH) in older people are increasing. There are concerns regarding an increased risk of a TIH in people taking oral anticoagulants (OAC) like phenprocoumon.


The aim of this study was to estimate the incremental risk of a TIH associated with OAC in older people. Furthermore, this study explored differences in risk according to functional status.


The study took data from a large German health insurance provider and combined hospital diagnoses with data regarding drug dispensing to estimate rates of a TIH in people with and without exposure to phenprocoumon. Analyses were stratified by sex and by severe functional impairment as disclosed by the long-term care insurance provider.


Overall, exposure to OAC resulted in 2.7 times higher rates of TIH. People with severe functional impairment had a higher baseline risk of TIH than people without severe functional impairment. However, the incremental risk in those exposed to OAC was similar among people with and without severe functional impairment (standardised incidence rate difference 15.73 (95% CI 7.84; 23.61) and 12.10 (95% CI 9.63; 14.57) per 10,000 person-years, respectively).


OAC increases the risk of TIH considerably. The incremental risk of TIH in those exposed to OAC is comparable between people with and without severe functional impairment. The presence of severe functional impairment per se should not exclude such patients from the potential benefits of OAC. For now, the prescription should be personalized based on individual fall risk factors and risk-taking behaviour.


Elderly Anticoagulation Head injury Intracranial haemorrhage Trauma 



We would like to thank Marianna Hanke-Ebersoll from the Allgemeine Ortskrankenkasse (AOK) for her support of our analyses.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of Ulm University.

Statement of human and animal rights

Conduction of the study was in accordance with the ethical standards of the institutional ethical committee and with the 1964 Helsinki declaration and its later amendments. This article does not contain any studies animals performed by any of the authors.

Informed consent

No informed consent was obtained.

Supplementary material

40520_2019_1215_MOESM1_ESM.docx (73 kb)
Supplementary material 1 (DOCX 73 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Institute of Epidemiology and Medical BiometryUlm UniversityUlmGermany
  2. 2.Department of Clinical GerontologyRobert Bosch Krankenhaus StuttgartStuttgartGermany
  3. 3.Center for Geriatric Medicine, Bethanien Krankenhaus HeidelbergUniversity of HeidelbergHeidelbergGermany
  4. 4.Faculty of Social and Health StudiesUniversity of Applied Sciences KemptenKemptenGermany

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