Time to Resume Oral Anticoagulant Therapy in Traumatic Intracranial Hemorrhage Patients, Balancing Recurrence, Thromboembolism, and Mortality: A Systematic Review.
Amaury Gossiome, Axel Benhamed, Anthony Labrecque-Binet et al.
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In 30 seconds
This systematic review examined when to resume oral anticoagulant therapy (OAC) after traumatic intracranial hemorrhage (ICH) and the associated hemorrhagic, thromboembolic, and mortality outcomes. Twelve cohort studies involving 13,528 patients were included; median resumption times ranged from 8 to 67 days. In studies restricted to traumatic ICH, resumption was not associated with increased recurrent ICH risk (RR 0.70 [95% CI, 0.52-0.95]; HR 0.45 [95% CI, 0.26-0.76]). Most studies reported fewer thromboembolic events after resumption, but the evidence did not establish a safe timeframe.
Key findings
- Across 12 cohort studies, median time to resume OAC ranged from 8 to 67 days.
- In studies limited to traumatic ICH, resumption was not associated with increased recurrence risk: RR 0.70 (95% CI, 0.52-0.95) and HR 0.45 (95% CI, 0.26-0.76).
- All but one study reported reduced thromboembolic events with OAC resumption.
- The studies suggested that complete resolution of the initial ICH may permit safe OAC resumption.
Why it matters
Resuming anticoagulation after traumatic ICH involves competing risks: recurrent bleeding and thromboembolism. This review suggests resumption may be possible in selected patients without a clear increase in recurrent ICH, while thromboembolic events may be reduced. However, the wide range of reported resumption times and lack of a defined safe timeframe leave an important uncertainty for clinical decision-making.
What to keep in mind
The evidence came from cohort studies, and the review could not define a safe resumption timeframe. Most patients received vitamin K antagonists; only 3 studies included patients taking direct oral anticoagulants.