Platelet Transfusion for Patients with Traumatic Intracranial Hemorrhage Taking Prehospital Antiplatelet Medication: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 229 (4) ◽  
pp. S305-S306
Author(s):  
Jurgis Alvikas ◽  
Sara Myers ◽  
Charles Wessel ◽  
Cody Doberstein ◽  
Wael Asaad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Hemorrhage ◽  
Platelet Transfusion ◽  
Meta Analysis ◽  
Antiplatelet Medication ◽  
Traumatic Intracranial Hemorrhage

scholarly journals LO45: Incidence of delayed intracranial hemorrhage following a mild traumatic brain injury in patients taking anticoagulants or anti-platelets therapies: systematic review and meta-analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S22-S22
Author(s):  
M. Emond ◽  
A. Laguë ◽  
T. O’Brien ◽  
B. Mitra ◽  
P. Tardif ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ct Scan ◽  
Intracranial Hemorrhage ◽  
Meta Analysis ◽  
Grey Literature ◽  
Experimental Studies ◽  
Discharge Plan ◽  
Mesh Terms ◽  
Traumatic Intracranial Hemorrhage ◽  
Clinically Significant

Introduction: Head injury is a common presentation to all emergency departments. Previous research has shown that such injuries may be complicated by delayed intracranial hemorrhage (D-ICH) after the initial scan is negative. Exposure to anticoagulant or anti-platelet medications (ACAP) may be a risk factor for D-ICH. We have conducted a systematic review and meta-analysis to determine the incidence of delayed traumatic intracranial hemorrhage in patients taking anticoagulants, anti-platelets or both. Methods: The literature search was conducted in March 2017 with an update in April 2017. Keyword and MeSH terms were used to search OVID Medline, Embase and the Cochrane database as well as grey literature sources. All cohort and experimental studies were eligible for selection. Inclusion criteria included pre-injury exposure to oral anticoagulant and / or anti-platelet medication and a negative initial CT scan of the brain (CT1). The primary outcome was delayed intracranial hemorrhage present on repeat CT scan (CT2) within 48 hours of the presentation. Only patients who were rescanned or observed minimally were included. Clinically significant D-ICH were those that required neurosurgery, caused death or necessitated a change in management strategy, such as admission. Results: Fifteen primary studies were ultimately identified, comprising a total of 3801 patients. Of this number, 2111 had a control CT scan. 39 cases of D-ICH were identified, with the incidence of D-ICH calculated to be 1.31% (95% CI [0.56, 2.27]). No more than 12 of these patients had a clinically significant D-ICH representing 0.09% (95% CI [0.00, 0.31]). 10 of them were on warfarin and two on aspirin. There were three deaths recorded and three patients needed neurosurgery. Conclusion: The relatively low incidence suggests that repeat CT should not be mandatory for patients without ICH on first CT. This is further supported by the negligibly low rate of clinically significant D-ICH. Evidence-based assessments should be utilised to indicate the appropriate discharge plan, with further research required to guide the balance between clinical observation and repeat CT.

Systematic Review and Meta-Analysis: Is Pre-Injury Antiplatelet Therapy Associated with Traumatic Intracranial Hemorrhage?

2017 ◽  
Vol 34 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Crispijn L. van den Brand ◽  
Tanya Tolido ◽  
Anna H. Rambach ◽  
Myriam G.M. Hunink ◽  
Peter Patka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antiplatelet Therapy ◽  
Intracranial Hemorrhage ◽  
Meta Analysis ◽  
Traumatic Intracranial Hemorrhage

Incidence and mortality rates of intracranial hemorrhage in hemophilia: a systematic review and meta-analysis

Blood ◽  
2021 ◽  
Author(s):  
Anne-Fleur Zwagemaker ◽  
Samantha C Gouw ◽  
Julie J Jansen ◽  
Caroline Vuong ◽  
Michiel Coppens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Young Adults ◽  
Intracranial Hemorrhage ◽  
Meta Analysis ◽  
Age Groups ◽  
Mortality Rates ◽  
Normal Model ◽  
Live Births ◽  
Incidence And Mortality ◽  
Children And Young Adults

Intracranial hemorrhage (ICH) is a severe complication that is relatively common among hemophilia patients. This systematic review aimed to obtain more precise estimates of ICH incidence and mortality in hemophilia, which may be important for patients, caregivers, researchers and health policy-makers. PubMed and EMBASE were systematically searched using terms related to "hemophilia" and "intracranial hemorrhage" or "mortality". Studies that allowed calculation of ICH incidence or mortality rates in a hemophilia population of at least 50 patients were included. We summarized evidence on ICH incidence and calculated pooled ICH incidence and mortality in three age groups: (1) persons of all ages with hemophilia, (2) children and young adults below 25 years of age with hemophilia and (3) neonates with hemophilia. Incidence and mortality were pooled with a Poisson-Normal model or a Binomial-Normal model. We included 45 studies that represented 54 470 patients, 809 151 person-years and 5326 live births of hemophilia patients. In persons of all ages, the pooled ICH incidence and mortality rates were 2.3 (95% CI 1.2-4.8) and 0.8 (95% CI 0.5-1.2) per 1000 person-years, respectively. In children and young adults, the pooled ICH incidence and mortality rates were 7.4 (95% CI 4.9-11.1) and 0.5 (95% CI 0.3-0.9) per 1000 person-years, respectively. In neonates, the pooled cumulative ICH incidence was 2.1% (95% CI 1.5-2.8) per 100 live births. ICH was classified as spontaneous in 35-58% of cases. Our findings suggest that ICH is an important problem in hemophilia that occurs among all ages, requiring adequate preventive strategies.

1615: TRAUMATIC INTRACRANIAL HEMORRHAGE AND ANTIPLATELET THERAPY: THE EFFICACY OF PLATELET TRANSFUSION

2018 ◽  
Vol 46 (1) ◽  
pp. 792-792
Author(s):  
Richard Wittmeyer ◽  
Christy Poole ◽  
Amy Cherico ◽  
Jennifer Chen ◽  
Brandon Boyer ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Intracranial Hemorrhage ◽  
Platelet Transfusion ◽  
Traumatic Intracranial Hemorrhage

Abstract WMP112: Cilostazol versus Aspirin for Secondary Stroke Prevention: Systematic Review and Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michelle P Lin ◽  
Kevin M Barrett ◽  
James F Meschia ◽  
Benjamin H Eidelman ◽  
Josephine F Huang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Random Effects ◽  
Intracranial Hemorrhage ◽  
Stroke Prevention ◽  
Lower Risk ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Secondary Stroke Prevention

Introduction: Cilostazol has promise as an alternative to aspirin for secondary stroke prevention given its vasodilatory and anti-inflammatory properties in addition to platelet aggregation inhibition. We conducted a systematic review and meta-analysis to estimate the comparative effectiveness and safety of cilostazol compared to aspirin for stroke prevention in patients with previous stroke or TIA. Hypothesis: Cilostazol is more effective than aspirin in preventing recurrent ischemic stroke with lower risk of intracranial hemorrhage and bleeding. Methods: We searched PubMed and the Cochrane Central Register of Controlled Trials from inception to 2019. Randomized clinical trials that compared cilostazol vs aspirin and reported the endpoints of ischemic stroke, intracranial hemorrhage and bleeding were included. A random-effects estimate was computed based on Mantel-Haenszel methods. The pooled estimates with 95% confidence intervals were compared between cilostazol and aspirin and displayed as forest plots (Figure). Results: The search identified 5 randomized clinical trials comparing cilostazol vs aspirin for secondary stroke prevention that enrolled 7,240 patients from primarily Asian countries (3,615 received cilostazol and 3,625 received aspirin). The pooled results from the random-effects model showed that cilostazol was associated with significantly lower risk of recurrent ischemic stroke (Hazard ratio [HR] 0.70; 95%CI, 0.54-0.89), intracranial hemorrhage (HR 0.41; 95%CI, 0.25-0.65) and bleeding (HR 0.71; 95%CI, 0.55-0.91). See forest plots. Conclusion: This meta-analysis suggests cilostazol is more effective than aspirin in the prevention of recurrent ischemic stroke with lower risk of intracranial hemorrhage and bleeding. Confirmatory randomized trials of cilostazol for secondary stroke prevention to be performed in more generalizable populations are needed.

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