Incidence and Risk Factors of Delayed Intracranial Hemorrhage in Anticoagulated Head Trauma Patients: A Systematic Review and Meta-Analysis

Objectives: This study aims to provide a current and comprehensive analysis of the incidence of delayed intracerebral hemorrhage (dICH) in head trauma patients on oral anticoagulants (ACs) and to evaluate various potential risk factors.

Methods: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. PubMed and Cochrane Central Register of Controlled Trials were searched for studies on dICH in anticoagulated head trauma patients undergoing repeat computed tomography scans. Studies reporting dICH incidence on repeat computed tomography within 24 hours of an initial negative scan were included. Data on demographics, AC type, risk factors, and clinical outcomes were extracted and analyzed.

Results: From 634 identified articles, 26 studies with 7218 patients were included. The overall incidence of dICH was 2.0%, with 43.8% of these cases requiring hospital admission or changes in clinical management. Only 0.1% required neurosurgical intervention, and 0.1% resulted in death. Meta-analysis of 20 studies revealed pooled dICH incidence per 1000 persons at risk was 27.1 for vitamin K antagonists and 20.5 for direct oral ACs. Significant risk factors for dICH included Glasgow Coma Scale <15, loss of consciousness, post-traumatic amnesia, and Abbreviated Injury Scale head ≥3.

Conclusions: A low incidence of dICH requires neurosurgical intervention; however, further studies are required to assess the need for other medical management in these patients. Furthermore, selective imaging for high-risk patients could improve care and resource allocation.