Delayed intracranial hemorrhage of patients with mild traumatic brain injury under antithrombotics on routine repeat CT scan: a systematic review and meta-analysis

ABSTRACT

Background

Patients on antithrombotics experiencing mild traumatic brain injury (mTBI) may benefit from a routine repeat CT scan to detect delayed intracranial hemorrhage (dICH).

Objectives

The primary outcome was the incidence of dICH on routine repeat CT scans of mTBI patients on antithrombotics within an intra-hospital observation period of up to 48 hours. The secondary outcomes were potential risk factors, readmissions, neurosurgical interventions, and mortality.

Methods

A systematic review and a meta-analysis of single proportions were performed according to the PRISMA and PRESS guidelines. The risk of bias was assessed using Newcastle-Ottawa Scale.

Results

Eighteen studies with 4613 patients were included. The pooled incidence of dICH was 2% [95% CI 1-2%] with similar rates between different antithrombotic regimens, even in combination. Of the 67 patients with dICH reported (1.45%), eleven required surgery (0.24%), while six died (0.13%). Loss of consciousness was a risk factor of dICH (risk ratio 3.04 [95%CI 0.96; 9.58]). A total of 48 patients were reported for readmission without associated death or surgical intervention.

Conclusion

The contribution of this routine repeat CT scan should be questioned due to the low incidence, the limited clinical significance, and the unsubstantiated clinical benefit of early or systematic detection of dICH.

KEYWORDS:

• Anticoagulants
• antiplatelets
• antithrombotics
• computed tomography
• direct oral anticoagulants
• mild traumatic brain injury

Acknowledgments

I am thankful to Ms. Ifigeneia Choutou and Ms. Chrysanthi‐Maria Moysidou for their help in editing and proofreading this manuscript.

Disclosure statement

The authors declare that they have no conflict of interest.

Code availability

R script used for the analysis could be provided upon request.

Ethical standards

For this type of study, formal consent was not required as it was given in each included study individually.

Presentation at a conference

A previous form of this study was presented as an oral presentation at the EANS (European Association of Neurosurgical societies) congress - Brussels 2018.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website

Additional information

Funding

The Aristotle University of Thessaloniki Aristotle University of Thessaloniki https://mrm. Provided financial support via a 50% grant of the master’s program tuition fee, for which this paper was required for graduation.