Premium
Incidence of intracranial bleeding in anticoagulated patients with minor head injury: a systematic review and meta‐analysis of prospective studies
Author(s) -
Minhas Hersimren,
Welsher Arthur,
Turcotte Michelle,
Eventov Michelle,
Mason Suzanne,
Nishijima Daniel K.,
Versmée Grégoire,
Li Meirui,
Wit Kerstin
Publication year - 2018
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15509
Subject(s) - medicine , apixaban , head injury , dabigatran , rivaroxaban , glasgow coma scale , warfarin , prospective cohort study , incidence (geometry) , edoxaban , stroke (engine) , anesthesia , surgery , atrial fibrillation , mechanical engineering , physics , optics , engineering
Summary Guidelines advise performing a computed tomography head scan for all anticoagulated head injured patients, but the risk of intracranial haemorrhage ( ICH ) after a minor head injury is unclear. We conducted a systematic review and meta‐analysis to determine the incidence of ICH in anticoagulated patients presenting with a minor head injury and a Glasgow Coma Score ( GCS ) of 15. We followed Meta‐Analyses and Systematic Reviews of Observational Studies guidelines. We included all prospective studies recruiting consecutive anticoagulated emergency patients presenting with a head injury. Anticoagulation included vitamin‐K antagonists (warfarin, fluindione), direct oral anticoagulants (apixaban, rivaroxaban, dabigatran and edoxaban) and low molecular weight heparin. A total of five studies (including 4080 anticoagulated patients with a GCS of 15) were included in the analysis. The majority of patients took vitamin K antagonists (98·3%). There was significant heterogeneity between studies with regards to mechanism of injury and methods. The random effects pooled incidence of ICH was 8·9% (95% confidence interval 5·0–13·8%). In conclusion, around 9% of patients on vitamin K antagonists with a minor head injury develop ICH . There is little data on the risk of traumatic intracranial bleeding in patients who have a GSC 15 post‐head injury and are prescribed a direct oral anticoagulant.