SynthesisJournal of neurology2018
Evaluation of the yield of 24-h close observation in patients with mild traumatic brain injury on anticoagulation therapy: a retrospective multicenter study and meta-analysis.
Synthesis in Journal of neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 45 citations in OpenAlex.
- Incidence of intracranial bleeding in mild traumatic brain injury patients taking oral anticoagulants: a systematic review and meta-analysis.Journal of neurology · 2024Pooled it
- Incidence of delayed bleeding in patients on antiplatelet therapy after mild traumatic brain injury: a systematic review and meta-analysis.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Pooled it
- Deep learning algorithm in detecting intracranial hemorrhages on emergency computed tomographies.PloS one · 2021Trial
- [Diagnostic algorithm for the management of patients ≥ 65 years with a mild traumatic brain injury in the emergency department].Unfallchirurgie (Heidelberg, Germany) · 2026Review
- Clinical significance of head CT scan in patients admitted to the emergency department with mild head trauma.Internal and emergency medicine · 2026Article
- Performance Evaluation of a Commercial Deep Learning Software for Detecting Intracranial Hemorrhage in a Pediatric Population.Journal of imaging informatics in medicine · 2026Article
- Development of Machine-learning Model to Predict Anticoagulant Use and Type in Geriatric Traumatic Brain Injury Using Coagulation Parameters.Neurologia medico-chirurgica · 2025Article
- Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Observational
- Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department.Journal of clinical medicine · 2024Review
- The prevalence of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants is very low: a retrospective cohort register study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
- In old anticoagulated patients with mild traumatic brain injury, a 24-h observation period should not be recommended without evidence of a clear benefit: a retrospective study of delayed hemorrhagic versus iatrogenic complications.Internal and emergency medicine · 2024Article
- Early Discharge versus 6-hour Observation in Mild Traumatic Brain Injury with Normal Brain CT Scan; a Comparative Pilot study of Outcomes.Archives of academic emergency medicine · 2024Article
- Delayed intracranial hemorrhage after head trauma seems rare and rarely needs intervention-even in antiplatelet or anticoagulation therapy.International journal of emergency medicine · 2023Article
- Management of Traumatic Brain Injury in Patients with DOAC Therapy-Are the "New" Oral Anticoagulants Really Safer?Journal of clinical medicine · 2022Article
- Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists.Medicina (Kaunas, Lithuania) · 2020Observational
- Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy.Journal of clinical medicine · 2019Article
- Diagnostic and therapeutic approach in adult patients with traumatic brain injury receiving oral anticoagulant therapy: an Austrian interdisciplinary consensus statement.Critical care (London, England) · 2019Article
- Acute and Delayed Intracranial Hemorrhage in Head-Injured Patients on Warfarin versus Direct Oral Anticoagulant Therapy.Journal of emergencies, trauma, and shockArticle
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND/
aimsPatients with mild traumatic brain injury (mTBI) on anticoagulants have an increased risk of intracranial hemorrhage (ICH). However, consensus is lacking on whether to admit them after normal initial cranial CT. We evaluated the yield of 24-h neurological observation.
methodsRetrospective multicenter study including adult patients admitted over a 5-year period with mTBI on anticoagulation [therapeutic dose heparin, direct oral anticoagulant, or vitamin K antagonist (VKA) with international normalized ratio (INR) ≥ 1.7] and reportedly normal cranial CT obtained within 24 h after trauma. Primary endpoint was symptomatic ICH within 24 h of injury. Literature on delayed ICH in patients with mTBI and anticoagulation use was reviewed.
resultsOf 17.643 mTBI patients, 905 met the inclusion criteria (median age 82 years). 97% used VKA (median INR 2.9). None developed delayed ICH within 24 h. Nine patients deteriorated neurologically due to ICH, four within 24 h (0.4%, 95% CI 0.1-1.2) and five on day 2, 18, 22, 36 and 52, respectively. In six patients, including all four that developed symptoms within 24 h, ICH was found upon reevaluation of initial imaging. The meta-analysis comprised of 9 studies with data from 2885 patients. The estimated pooled proportion of symptomatic delayed ICH or delayed diagnosis of ICH within 24 h was 0.2% (95% CI 0.0-0.5).
conclusionsDelayed (diagnosis of) ICH within 24 h is very rare in mTBI patients on anticoagulants after reportedly normal initial CT. Routine hospitalization of these patients seems unwarranted when the initial cranial CT is scrupulously evaluated.
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