{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:55:18Z","timestamp":1787018118398,"version":"build-2736575974"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Purpose\u2014<\/jats:title>\n                    <jats:p>Subdural hematomas are an important bleeding complication of anticoagulation. We quantify the risk of subdural hematoma associated with anticoagulation with vitamin K antagonists (VKAs) compared with other oral antithrombotic therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\u2014<\/jats:title>\n                    <jats:p>Randomized trials were identified from the Cochrane Central Register of Controlled Trials and were included if published since 1980 and compared oral VKAs with antiplatelet therapy or with direct-acting oral anticoagulants. Two reviewers independently extracted data with differences resolved by joint review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results\u2014<\/jats:title>\n                    <jats:p>Nineteen randomized trials were included that involved 92 156 patients and 275 subdural hematomas. By meta-analysis, VKAs were associated with a significantly increased risk of subdural hematoma (odds ratios, 3.0; 95% confidence interval, 1.5\u20136.1) compared with antiplatelet therapy (9 trials, 11 603 participants). The risk of subdural hematoma was also significantly higher with VKAs versus factor Xa inhibitors (meta-analysis odds ratios, 2.9; 95% confidence interval, 2.1\u20134.1; 5 trials, 49 687 patients) and direct thrombin inhibitors (meta-analysis odds ratios, 1.8; 95% confidence interval, 1.2\u20132.7; 5 trials, 30 866 patients) versus VKAs. The absolute rate of subdural hematoma among 24 485 patients with atrial fibrillation treated with VKAs pooled from 6 trials testing direct-acting oral anticoagulants was 2.9 (95% confidence interval, 2.5\u20133.5) per 1000 patient-years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>VKA use significantly increases the risk of subdural hematoma by \u22483-fold relative to antiplatelet therapy. Direct-acting oral anticoagulants are associated with a significantly reduced risk of subdural hematomas versus VKAs. Based on indirect comparisons to VKAs, the risks of subdural hematoma are similar with antiplatelet monotherapies and factor Xa inhibitors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.114.005430","type":"journal-article","created":{"date-parts":[[2014,5,13]],"date-time":"2014-05-13T23:36:32Z","timestamp":1400024192000},"page":"1672-1678","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Vitamin K Antagonists and Risk of Subdural Hematoma"],"prefix":"10.1161","volume":"45","author":[{"given":"Ben J.","family":"Connolly","sequence":"first","affiliation":[{"name":"From the Population Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (B.J.C., R.G.H.); and Biostatistics Consultant, Minot, ND (L.A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesly A.","family":"Pearce","sequence":"additional","affiliation":[{"name":"From the Population Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (B.J.C., R.G.H.); and Biostatistics Consultant, Minot, ND (L.A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Hart","sequence":"additional","affiliation":[{"name":"From the Population Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (B.J.C., R.G.H.); and Biostatistics Consultant, Minot, ND (L.A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2006.07.034"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.110.593087"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.112.650614"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.108.830232"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.042"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-9-201111010-00004"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.21.2058"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(95)00134-4"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1761"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410420606"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043033"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61233-1"},{"key":"e_1_3_3_15_2","first-page":"687","article-title":"Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study.","volume":"343","author":"Stroke Prevention in Atrial Fibrillation Investigators","year":"1994","unstructured":"Stroke Prevention in Atrial Fibrillation Investigators. 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