Meta AnalysisID 5493
服用维生素K拮抗剂和直接口服抗凝药的头部损伤患者迟发性颅内出血风险的管理
CRD42022341582
In anticoagulated patients with a head injury who have traumatic brain injury excluded with head CT: 1) Does continuing versus holding their prescribed anticoagulation reduce the risk of delayed intracranial bleeding wit
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Record Fields
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- Meta Analysis Id
- 5493
- Evidence Id
- 14051
- Core Evidence Id
- 14051
- Source Meta Analysis Id
- 5477
- Herb2 Meta Analysis Id
- HBMA005477
- Crd Id
- CRD42022341582
- Title
- Managing the risk of delayed intracranial bleeding in head injured patients taking vitamin K antagonists and direct oral anticoagulant medications.
- Review Question
- In anticoagulated patients with a head injury who have traumatic brain injury excluded with head CT: 1) Does continuing versus holding their prescribed anticoagulation reduce the risk of delayed intracranial bleeding within 90 days?2) Does continuing versus holding their prescribed anticoagulation reduce the risk of thrombotic complications within 90 days? 3) Does the reported rate of delayed intracranial bleeding differ between patients prescribed vitamin K antagonists and direct oral anticoagulants? 4) Does the mortality associated with a delayed intracranial bleed differ between patients prescribed vitamin K antagonists and direct oral anticoagulants?
- Study Type Included
- Randomized controlled studies, prospective and retrospective cohort studies will be included in the analysis.
- Condition Being Studied
- Older individuals are more likely to have comorbidities and be prescribed anticoagulants. Around 10% of older adults are prescribed anticoagulant medications such as direct oral anticoagulants and the vitamin K antagonists. For patients on anticoagulants, even after an initial normal CT head scan, there is risk of delayed intracranial bleeding with mild head trauma. Delayed bleeding can occur days to months post head trauma. Conversely, if anticoagulants are held for too long, the patient is at increased risk of thrombotic events. It is not clear if continuing versus holding prescribed anticoagulant medications will impact risk of delayed intracranial bleeding or reduce the risk of thrombotic complications. It is not clear if there is a difference in rate of delayed intracranial bleeding between patients prescribed Vitamin K antagonists and direct oral anticoagulants or if there is a difference in mortality between the two groups.
- Participant
- Inclusion Criteria: Head injured patients presenting to the emergency department who take vitamin K antagonist or direct oral anticoagulant medications, and who have an initial head CT which rules out traumatic brain injury.
- Animal
- Human Disease Modelled
- Intervention
- The exposures are use of vitamin K antagonist or direct oral anticoagulant medications (over at least the prior 5 days).
- Comparator Control
- We will compare the outcomes for patients who take vitamin K antagonist to patients who take direct oral anticoagulant medications.
- Main Outcome
- The primary outcome will be delayed intracranial bleeding within 90 days within any intracranial compartment Measures of effect A random-effect model will be used to calculate the pooled relative risk. We will report the relative risk, and associated 95% confidence intervals, of intracranial bleeding.
- Outcome Measure
- Additional Outcome
- Mortality from delayed intracranial bleeding. Measures of effect We will report the proportion of patients with delayed intracranial bleeding on vitamin K antagonists and direct oral anticoagulants who die.
- Study Method
- Epidemiologic, Intervention, Meta-analysis, Systematic review
- Keyword
- Anticoagulants; Humans; Vitamin K; Warfarin
- Contact
- Monika Stodulska [email protected]
- Organisational Affiliation
- Queen's University https://meds.queensu.ca/
- Funding Source
- None Grant number(s) <span style=font-size: 14px>State the funder, grant or award number and the date of award</span> None
- Other Selection Criteria
- Final Publication
- Same Topic Review
- Published Protocol
- Review Type
- Language
- English
- Country
- Canada
- Review Stage
- Review Ongoing
- First Submission Date
- 2022-07-29
- Registration Date
- 2022-08-09
- Anticipated Start Date
- 2022-06-21
- Anticipated Completion Date
- 2023-12-31
- Title Cn
- 服用维生素K拮抗剂和直接口服抗凝药的头部损伤患者迟发性颅内出血风险的管理
- Title En
- Managing the risk of delayed intracranial bleeding in head injured patients taking vitamin K antagonists and direct oral anticoagulant medications.
- Bilingual Status
- complete