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

Autor: Minhas H; Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA., Welsher A; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada., Turcotte M; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada., Eventov M; School of Medicine, Wayne State University, Detroit, MI, USA., Mason S; CURE School of Health and Related Research, University of Sheffield, Sheffield, UK., Nishijima DK; Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA., Versmée G; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA., Li M; Department of Anatomical Pathology, Western University, London, ON, Canada., de Wit K; Divisions of Emergency Medicine and Hematology, McMaster University, Hamilton, ON, Canada.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2018 Oct; Vol. 183 (1), pp. 119-126. Date of Electronic Publication: 2018 Jul 20.
DOI: 10.1111/bjh.15509
Abstrakt: 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.
(© 2018 British Society for Haematology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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