OC 51.1 - Risk of delayed intracranial hemorrhage according to antithrombotic treatment in patients with traumatic brain injury: Systematic Review and Meta-Analysis

Background: Antithrombotic treatment is a risk factor for the development of delayed (DICH) intracranial hemorrhage after head trauma. However, it is not known whether i) the risk of DICH differs according to antithrombotic treatments and ii) prescription of serial brain-CT after a first normal CT scan is indicated.

Aims: The aims of this study are: i) to evaluate the risk of DICH after traumatic brain injury (TBI) according to different antithrombotic treatments (vitamin K antagonist [VKA], direct oral anticoagulants [DOACs], antiplatelets [AP]); ii) to evaluate the usefulness of serial CT scans vs clinical observation to rule out a DICH.

Methods: Medline and Embase databases were searched up to June 2022 to find studies with the following criteria: i) enrolling TBI patients admitted to emergency departments within 24 hours since trauma; ii) enrolling patients who were receiving VKA, DOACs or APs at time of TBI; iii) had a normal brain-CT scan at admission. The primary study outcome was DICH, defined as the presence of subdural, epidural or parenchymal haematoma, subarachnoid haemorrhage or cerebral contusion.

Results: 3070 records were identified, and 27 observational studies were included. No significant difference in the risk of DICH was observed in patients receiving VKAs or DOACs ( 6078 patients) at the time of TBI: 2.52% vs 2.01%, risk ratio (RR) 1.40, 95% CI 0.91;2.14 (Fig.1A). Similarly, no difference was observed between patients receiving VKAs or APs (3864 patients): 1.43% vs 1.54%, RR 0.92, CI 95% 0.40;2.14; and between DOACs or APs (1916 patients): 0.87% vs AP 1.81 %, RR 0.62, 95% CI 0.10-3.71 (Fig. 1B). No studies comparing serial brain-CT vs clinical observation were found.

Conclusion(s): Our study shows that the risk of developing DICH after TBI does not differ across the antithrombotic treatments. Further studies should assess the role of serial brain CT in this setting.