Clive Hyman
22 Jan 2026 · Coroner Sarah Bourke · Inner North London
The coroner's concerns
1. delayed presentation of intracranial bleed
“Public health literature and other non-medical sources of advice ... should encourage people who have any concerns after a head injury ... to seek immediate medical advice. Paragraphs 1.2.3 and 1.2.4 of the guidance state that remote advice services and community health services "should refer people who have sustained a head injury to a hospital emergency department ... if there are any of these risk factors ... current anticoagulant or antiplatelet (except aspirin monotherapy) treatment"”
2. lack of awareness of head injury risk while on apixaban
“Patients who have experienced head trauma may not realise that they have sustained an intracranial bleed. As head injuries can be asymptomatic for some time following trauma, apixaban users may continue taking the medication and avoid seeking medical advice because they feel well. As a result of taking apixaban, bleeding may continue. By the time symptoms of a brain injury emerge (e.g. a sudden, severe headache) the patient may be critically ill and have a reduced potential for recovery”
3. inadequate patient information on head trauma management while on apixaban
“Having reviewed several patient information leaflets issued with apixaban, it is evident that patients are routinely advised not to take the drug if they are "bleeding excessively". In addition, they are advised to seek medical advice if they are at "increased risk of bleeding". None of the patient information leaflets that I reviewed expressly addressed the steps to be taken by a patient if they sustain trauma to the head”