Introduction The management of anticoagulation (AC) therapy in patients with central nervous system (CNS) haemorrhage remains challenging. This study examines the potential factors associated with spinal haematoma among patients who develop CNS haemorrhage while on AC therapy.

Methods Based on a systematic review using MEDLINE and EMBASE, two reviewers screened publications and extracted data on all CNS-haemorrhage cases. First, all cases were grouped into brain, posterior fossa and spinal haemorrhage. Second, the spinal-haemorrhage group was subdivided into those patients experiencing complete neurological recovery, incomplete recovery, no recovery and death. Finally, axonal survival and inflammatory response after spinal cord injury (SCI) due to trauma and spinal haemorrhage were examined using postmortem spinal cord tissue.

Results Data were extracted from 72 publications including 553 patients. There were significant differences among the CNS groups regarding patient characteristics and management, while their outcomes were comparable. Outcomes among the spinal-haemorrhage subgroups were not associated with patient characteristics and management. Postmortem examination of spinal cord showed that axonal survival and inflammatory response in a spinal-haemorrhage case were similar to a case of traumatic SCI.

Conclusions The results of this study suggest that the management of patients with spinal haemorrhage considerably differ from individuals with an intracranial haemorrhage during AC. However, survival and neurological recovery appear to be comparable among the CNS groups. The studied factors failed to discriminate the patient subgroups according to survival and neurological recovery. Finally, the neuropathology result reinforces the possibility that the mechanism of SCI may not be relevant for axonal survival and inflammatory response within the spinal cord.