Stroke risk following traumatic brain injury: systematic review and meta-analysis

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Abstract

Background: Traumatic brain injury is a global health problem; worldwide, >60 million people experience a traumatic brain injury each year and incidence is rising. Traumatic brain injury has been proposed as an independent risk factor for stroke. Aims: To investigate the association between traumatic brain injury and stroke risk. Summary of review: We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4 December 2020. We used random-effects meta-analysis to pool hazard ratios for studies which reported stroke risk post-traumatic brain injury compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-traumatic brain injury control group, all found traumatic brain injury patients had significantly increased risk of stroke compared to controls (pooled hazard ratio 1.86; 95% confidence interval 1.46–2.37). Findings suggest stroke risk may be highest in the first four months post-traumatic brain injury, but remains significant up to five years post-traumatic brain injury. Traumatic brain injury appears to be associated with increased stroke risk regardless of severity or subtype of traumatic brain injury. There was some evidence to suggest an association between reduced stroke risk post-traumatic brain injury and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion: Traumatic brain injury is an independent risk factor for stroke, regardless of traumatic brain injury severity or type. Post-traumatic brain injury review and management of risk factors for stroke may be warranted.

Original languageEnglish
Pages (from-to)1-15
JournalInternational Journal of Stroke
Early online date11 Mar 2021
DOIs
Publication statusPublished - 4 Apr 2021

Bibliographical note

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC). GMT is funded by the NIHR Postdoctoral Fellowship program (PDF-2017-10-047) and NIHR SRMRC. MC is an NIHR Senior Investigator and receives funding from the NIHR Birmingham Biomedical Research Centre, NIHR SRMRC and NIHR Applied Research Collaboration (ARC) West Midlands at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Health Data Research UK, Innovate UK, part of UK Research and Innovation, and Macmillan Cancer Support. OLA receives funding from the Health Foundation, an independent charity working to improve the quality of healthcare in the UK. He also receives funding from the NIHR Birmingham Biomedical Research Centre and NIHR ARC West Midlands. TM is supported by the NIHR ARCWest Midlands. The views expressed are those of the authors are not necessarily those of the NHS, the NIHR, the Health Foundation or the Department of Health and Social Care. The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Keywords

  • Traumatic brain injury
  • meta-analysis
  • risk
  • stroke
  • systematic review
  • traumatic brain injury

ASJC Scopus subject areas

  • Neurology

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