Coroner highlights lack of head injury warnings for anticoagulant

A coroner has warned that patient information leaflets for the anticoagulant apixaban (Eliquis; Bristol-Myers Squibb–Pfizer Alliance) do not “expressly address” steps patients should take if they sustain a head injury.

Sarah Bourke, area coroner for Inner North London, raised the concern in a ‘Prevention of future deaths’ report (PFD), published on 22 January 2026, following the death of Clive Hyman, aged 64 years, who tripped and hit his head while on apixaban after treatment for atrial fibrillation and a coronary artery bypass.

After a review of apixaban patient information leaflets, the coroner noted that — while patients are advised not to take apixaban if they are “bleeding excessively” and to seek medical advice if they are at increased risk of bleeding — patient information leaflets do not address what to do if a patient sustains trauma to the head.

The coroner wrote: “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.

“Neither [Hyman] nor his wife was aware that taking apixaban presented a risk in relation to head trauma,” she added.

On 1 August 2025, Hyman tripped and hit his head, after which he began feeling unwell on 5 August 2025.

The patient was then taken to an emergency department, where it was identified that he had a left-sided subdural haemorrhage and was given tranexamic acid to reverse apixaban. Hyman later had an ischaemic stroke and died on 10 August 2025.

The coroner issued the PFD to the Medicines and Healthcare products Regulatory Agency (MHRA), Association of the British Pharmaceutical Industry (ABPI) and Medicines UK, which have 56 days to respond with details of actions taken or proposed to be taken.

Mark Samuels, chief executive of Medicines UK, commented: “First and foremost, we extend our condolences to the family of Clive Hyman. We acknowledge the coroner’s comments and are committed to liaising with relevant authorities to identify appropriate changes that can be implemented to increase patient awareness in the future.”

A spokesperson for the MHRA said: “Patient safety is our top priority. We take all PFDs very seriously and will review the findings carefully alongside assessment of other relevant evidence before providing a full response within 56 days.”

The ABPI said it would respond to the coroner.