The Brain Injury Guidelines (BIG) classify traumatic brain injuries (TBIs) into three tiers to dictate treatment. Patients taking pre-injury blood thinners (anticoagulants or antiplatelets) are automatically upgraded to the highest risk category (BIG-3), requiring intense monitoring, repeat CT scans, and neurosurgical consultations—even if their actual injury is mild.

Researchers reviewed 69 patients (mean age 77.9, mostly injured from falls) who had minor brain injuries but were classified as BIG-3 solely because they took blood thinners.

Despite being on blood thinners, these patients faced virtually no complications:
– Only 2.9% (2 patients) showed any worsening on a repeat CT scan, and both remained neurologically stable.
– 0% suffered neurological decline or required emergency brain surgery.
– 0% died from their brain injury.

Automatically upgrading otherwise low-risk patients to BIG-3 status just because they take blood thinners may be unnecessary. Safely managing these patients under less intensive protocols could prevent over-testing and reduce the burden on hospital resources.

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