Oral anticoagulants are a very commonly used class of medication in the elderly. Traditional oral anticoagulants belong to three main categories, namely the coumarin derivatives, aspirin and clopidogrel. Coumarins include warfarin, acenocoumarol and phenprocoumon, which all inhibit vitamin K availability.This paper reviews the current knowledge relating to fall-related mortality as a result of TBI in elderly patients on oral anticoagulation (OAC). Several articles report that anticoagulant use does not adversely affect the outcomes of severe head injuries after a fall in elderly patients. [1-5]Fortuna et al. compared 416 younger (50 years of age and younger) and older (70 years of age and older) patients with blunt haemorrhagic brain injuries who used clopidogrel, aspirin, or warfarin prior to injury with those who did not.[1] While the use of clopidogrel, aspirin, or warfarin was higher in the older patient group, it did not increase or change the mortality in elderly users of anticoagulation as compared to the younger group that used these anticoagulants. However, mortality in the older patient group who were not using clopidogrel, aspirin, or warfarin prior to injury was significantly increased as compared to the younger non-anticoagulant user group.[1] In addition, mortality was actually lower in the over-70 patient group who were using oral anticoagulants as compared to those who were not. Authors have suggested a beneficial effect of anticoagulant use secondary to a reduction in the incidence of thromboembolic injury following severe head trauma, which is known to induce a hypercoagulable state.[1][2]A very recent meta-analysis of the effect of pre-injury anticoagulant use found a trend towards worse outcome.[3] However, due to the disparity between the types of anticoagulants used and the patient populations, no firm conclusions could be drawn as to the impact of use of OAC on mortality and recovery.Much work remains to be done in determining the exact significance of the association observed in some studies. The use of different anticoagulants and different protocols, with variations in the INR allows for the limiting effect of many confounding factors. Future studies need to study the individual anticoagulants in specific protocols with sufficient sample size to allow valid conclusions to be drawn, and a valid control group.The INR at admission should be monitored to allow clinical protocols to evolve with the least risk of hemorrhagic complications following trauma. An admission CT might be advisable in all patients with a GCS between 13-15 and repeated if any worsening of the neurological status is observed, in view of the risk of worsening of trivial TBI with a paradoxically high mortality rate reported in several studies [1-5]. These steps need to be studied and their value reported on to begin reducing the dismal outcome of TBI in this group.