• Sean Hickey, Zachary L Hickman, John Conway, and Al Giwa.
• Department of Emergency Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York.
• J Emerg Med. 2021 Mar 1; 60 (3): 321-330.

BackgroundThe use of anticoagulant medications leads to a higher risk of developing traumatic intracranial hemorrhage (tICH) after a mild traumatic brain injury (mTBI). The management of anticoagulated patients can be difficult to determine when the initial head computed tomography is negative for tICH. There has been limited research on the risk of delayed tICH in patients taking direct oral anticoagulant (DOAC) medications.ObjectiveOur aim was to determine the risk of delayed tICH for patients anticoagulated with DOACs after mTBI.MethodsWe conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched several medical databases to examine the risk of delayed tICH in patients on DOACs.ResultsThere were 1252 nonduplicate studies that were identified through an initial database search, 15 of which met our inclusion and exclusion criteria and were included in our analysis after full-text review. A total of 1375 subjects were combined among the 15 studies, with 20 instances of delayed tICH after mTBI. Nineteen of the 20 patients with a delayed tICH were discharged without any neurosurgical intervention, and 1 patient on apixaban died due to a delayed tICH.ConclusionsThis systematic review confirms that delayed tICH after mTBI in patients on DOACs is uncommon. However, large, multicenter, prospective studies are needed to confirm the true incidence of clinically significant delayed tICH after DOAC use. Due to the limited data, we recommend using shared decision-making for patients who are candidates for discharge.Copyright © 2020 Elsevier Inc. All rights reserved.

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