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

3 Citations (Scopus)

Abstract

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
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Craniocerebral Trauma
Meta-Analysis
Prospective Studies
Hemorrhage
Intracranial Hemorrhages
Incidence
Vitamin K
Coma
Anticoagulants
Head
Guidelines
Low Molecular Weight Heparin
Warfarin
Observational Studies
Emergencies
Tomography
Confidence Intervals
Wounds and Injuries

Keywords

  • Anticoagulation
  • Minor head injury

ASJC Scopus subject areas

  • Hematology

Cite this

Incidence of intracranial bleeding in anticoagulated patients with minor head injury : A systematic review and meta-analysis of prospective studies. / Minhas, Hersimren; Welsher, Arthur; Turcotte, Michelle; Eventov, Michelle; Mason, Suzanne; Nishijima, Daniel; Versmée, Grégoire; Li, Meirui; de Wit, Kerstin.

In: British Journal of Haematology, 01.01.2018.

Research output: Contribution to journalArticle

Minhas, Hersimren ; Welsher, Arthur ; Turcotte, Michelle ; Eventov, Michelle ; Mason, Suzanne ; Nishijima, Daniel ; Versmée, Grégoire ; Li, Meirui ; de Wit, Kerstin. / Incidence of intracranial bleeding in anticoagulated patients with minor head injury : A systematic review and meta-analysis of prospective studies. In: British Journal of Haematology. 2018.
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