Incidence of intracranial bleeding in anticoagulated patients with minor head injury: a systematic review and meta‐analysis of prospective studies Journal Articles uri icon

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  • SummaryGuidelines 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.


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

publication date

  • October 2018