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Risk Factors for Anticoagulant-Associated Intracranial Hemorrhage: A Systematic Review and Meta-analysis

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Abstract

Background

Anticoagulant-associated intracranial hemorrhage has a high mortality rate, and many factors can cause intracranial hemorrhage. Until now, systematic reviews and assessments of the certainty of the evidence have not been published.

Methods

We conducted a systematic review to identify risk factors for anticoagulant-associated intracranial hemorrhage. The protocol for this systematic review was prospectively registered with PROSPERO (CRD42022316750). All English studies that met the inclusion criteria published before January 2022 were obtained from PubMed, EMBASE, Web of Science, and Cochrane Library. Two researchers independently screened articles, extracted data, and evaluated the quality and evidence of the included studies. Risk factors for intracranial hemorrhage were used as the outcome index of this review. Random or fixed-effect models were used in statistical methods. I2 statistics were used to evaluate heterogeneity.

Results

Of 7322 citations, we included 20 studies in our analysis. For intracranial hemorrhage, moderate-certainty evidence showed a probable association with race, Glasgow Coma Scale, stroke, leukoaraiosis, cerebrovascular disease, tumor, atrial fibrillation, previous bleeding, international normalized ratio, serum albumin, prothrombin time, diastolic blood pressure, and anticoagulant. Low-certainty evidence may be associated with age, cerebral microbleeds, smoking, alcohol intake, platelet count, and antiplatelet drug. In addition, we found very low-certainty evidence that there may be little to no association between the risk of intracranial hemorrhage and hypertension and creatinine clearance. Leukoaraiosis, cerebral microbleeds, cerebrovascular disease, and international normalized ratio are not included in most risk assessment models.

Conclusions

This study informs risk prediction for anticoagulant-associated intracranial hemorrhage and informs guidelines for intracranial hemorrhage prevention and future research.

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Abbreviations

ICH:

Intracranial hemorrhage

RAM:

Risk assessment model

OR:

Odds ratio

RR:

Risk ratio

HR:

Hazard ratio

CI:

Confidence interval

PROBAST:

The Prediction Study Risk of Bias Assessment Tool

QUIPS:

The Quality in Prognosis Studies tool

AF:

Atrial fibrillation

VTE:

Venous thromboembolism

GCS:

Glasgow Coma Scale

BGPVS:

Basal ganglia perivascular spaces

MCA:

Middle cerebral artery

DVT:

Deep vein thrombosis

INR:

International normalized ratio

PT:

Prothrombin time

DBP:

Diastolic blood pressure

eGFR:

Estimated glomerular filtration rate

CrCl:

Creatinine clearance

OAC:

Oral anticoagulant

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  1. Zhiwei Zeng and Jiana Chen contributed equally to the article.

Authors and Affiliations

  1. Department of Pharmacy, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China

    Zhiwei Zeng, Jiana Chen, Jiafen Qian, Fuxin Ma & Jinhua Zhang

  2. Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China

    Meina Lv

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Contributions

All authors made a substantial contribution to the concept and design of the study, interpreted the data, and reviewed the article. ZZW and CJN initiated the study. ZZW, CJN, QJF, and MFX performed data extraction and analyses and drafted the first version of the article. CJN, LMN, and ZJH critically reviewed the article and revised it. The final manuscript was approved by all authors.

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Correspondence to Jinhua Zhang.

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Zeng, Z., Chen, J., Qian, J. et al. Risk Factors for Anticoagulant-Associated Intracranial Hemorrhage: A Systematic Review and Meta-analysis. Neurocrit Care 38, 812–820 (2023). https://doi.org/10.1007/s12028-022-01671-4

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