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

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-09-10 DOI:10.1016/j.wneu.2024.09.018

Renato Luís Pessôa,Gabriel Moretti Garcia,Gabriel Goerck Becker,Eduardo Henrique Guadagnin,Lucas Pires Freitas,Eduardo Mensch Jaeger,Andrea de Vargas Tomelero,André Pinheiro Weber,Guilherme Henrique Ávila do Carmo

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Abstract

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 and to evaluate various potential risk factors. METHODS We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. PubMed and CENTRAL were searched for studies on dICH in anticoagulated head trauma patients undergoing repeat CT scans. Studies reporting dICH incidence on repeat CT within 24 hours of an initial negative scan were included. Data on demographics, anticoagulant 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 (VKAs) and 20.5 for direct oral anticoagulants (DOACs). Significant risk factors for dICH included Glasgow Coma Scale (GCS) <15, loss of consciousness, post-traumatic amnesia, and Abbreviated Injury Scale (AIS) 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.

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抗凝头部创伤患者延迟性颅内出血的发生率和风险因素：系统回顾与元分析》。

目的：本研究旨在对口服抗凝药的头部外伤患者延迟性脑内出血（dICH）的发生率进行最新的全面分析，并评估各种潜在的风险因素。方法：我们按照 PRISMA 和 MOOSE 指南进行了系统性回顾和荟萃分析。我们在 PubMed 和 CENTRAL 上检索了有关接受重复 CT 扫描的抗凝头部外伤患者 dICH 的研究。纳入的研究报告了在初次扫描阴性后 24 小时内重复 CT 的 dICH 发生率。结果从 634 篇已确定的文章中，共纳入了 26 项研究，7218 名患者。dICH的总发病率为2.0%，其中43.8%的病例需要入院治疗或改变临床治疗方案。只有0.1%的病例需要神经外科干预，0.1%的病例导致死亡。对20项研究进行的元分析表明，每1000名风险人群中，维生素K拮抗剂（VKA）和直接口服抗凝剂（DOAC）的dICH发病率分别为27.1和20.5。dICH的重要风险因素包括格拉斯哥昏迷量表（GCS）<15、意识丧失、创伤后遗忘和简易损伤量表（AIS）头部≥3。此外，对高危患者进行选择性成像可改善护理和资源分配。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.