Introduction Delayed intracranial hemorrhage (ICH) after negative initial head cat scan (CT) is a recognized complication after blunt trauma. Due to theoretical increased risk in patients on direct oral anticoagulants (DOACs) and inability to monitor degree of anticoagulation, there is a lack of consensus regarding need for observation or repeat imaging. We hypothesized that patients on DOACs would have low risk of delayed ICH after blunt head trauma. Methods In June 2020, an electronic literature search of MEDLINE (Ovid), Embase (Elsevier), and Cochrane Library was performed by a medical librarian. Included studies reported outcomes on adult trauma patients taking anticoagulants that were observed after initial normal head CT. A meta-analysis was performed using random effects model. Results Our electronic search returned 5719 papers with 12 meeting final inclusion/exclusion criteria. Overall, 5289 patients were studied including 1263 (23.9%) on DOAC and 1788 (33.8%) on warfarin. Sixty-nine patients suffered delayed ICH, 25 on DOAC and 44 on warfarin. The pooled weighted percentage for delayed ICH on DOAC was 2.43% (95% CI, 1.31 – 3.88%) compared to 2.31% (95% CI, 1.26 – 3.66%) on warfarin. The overall crude risk of death from delayed ICH while on DOAC or Warfarin was 0.36% (11/3051). Conclusions The risk of delayed ICH following low energy blunt head trauma for patients on DOACs is low, and risk of clinically significant bleeding is even lower. The practice of routinely observing or systematically reimaging patients on DOACs after low energy blunt head trauma with initially negative head CT may not be warranted.