Incidence of intracranial bleeding in anticoagulated patients with minor head injury: A systematic review and meta-analysis of prospective studies

Hersimren Minhas, Arthur Welsher, Michelle Turcotte, Michelle Eventov, Suzanne Mason, Daniel Nishijima, Grégoire Versmée, Meirui Li, Kerstin de Wit

Research output: Contribution to journalArticle

5 Scopus citations


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.

Original languageEnglish (US)
JournalBritish Journal of Haematology
StateAccepted/In press - Jan 1 2018



  • Anticoagulation
  • Minor head injury

ASJC Scopus subject areas

  • Hematology

Cite this