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 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.