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

Research output: Contribution to journalReview articlepeer-review

Colleges, School and Institutes


Background: Traumatic brain injury (TBI) is a global health problem; worldwide, >60 million people experience a TBI each year and incidence is rising. TBI has been proposed as an independent risk factor for stroke. AimsTo investigate the association between TBI and stroke risk.

Summary of review: We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI 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-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants.

Conclusion: TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.


Original languageEnglish
Pages (from-to)1-52
JournalInternational Journal of Stroke
Issue number00
Early online date11 Mar 2021
Publication statusE-pub ahead of print - 11 Mar 2021