RT Journal Article
SR Electronic
T1 Intracerebral haemorrhage in patients taking different types of oral anticoagulants: a pooled individual patient data analysis from two national stroke registries
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 640
OP 651
DO 10.1136/svn-2023-002813
VO 9
IS 6
A1 Siepen, Bernhard M
A1 Forfang, Elisabeth
A1 Branca, Mattia
A1 Drop, Boudewijn
A1 Mueller, Madlaine
A1 Goeldlin, Martina B
A1 Katan, Mira
A1 Michel, Patrik
A1 Cereda, Carlo
A1 Medlin, Friedrich
A1 Peters, Nils
A1 Renaud, Susanne
A1 Niederhauser, Julien
A1 Carrera, Emmanuel
A1 Kahles, Timo
A1 Kägi, Georg
A1 Bolognese, Manuel
A1 Salmen, Stephan
A1 Mono, Marie-Luise
A1 Polymeris, Alexandros A
A1 Wegener, Susanne
A1 Z'Graggen, Werner
A1 Kaesmacher, Johannes
A1 Schaerer, Michael
A1 Rodic, Biljana
A1 Kristoffersen, Espen Saxhaug
A1 Larsen, Kristin T
A1 Wyller, Torgeir Bruun
A1 Volbers, Bastian
A1 Meinel, Thomas R
A1 Arnold, Marcel
A1 Engelter, Stefan T
A1 Bonati, Leo H
A1 Fischer, Urs
A1 Rønning, Ole Morten
A1 Seiffge, David J
YR 2024
UL http://svn.bmj.com/content/9/6/640.abstract
AB Background We investigated outcomes in patients with intracerebral haemorrhage (ICH) according to prior anticoagulation treatment with Vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs) or no anticoagulation.Methods This is an individual patient data study combining two prospective national stroke registries from Switzerland and Norway (2013–2019). We included all consecutive patients with ICH from both registries. The main outcomes were favourable functional outcome (modified Rankin Scale 0–2) and mortality at 3 months.Results Among 11 349 patients with ICH (mean age 73.6 years; 47.6% women), 1491 (13.1%) were taking VKAs and 1205 (10.6%) DOACs (95.2% factor Xa inhibitors). The median percentage of patients on prior anticoagulation was 23.7 (IQR 22.6–25.1) with VKAs decreasing (from 18.3% to 7.6%) and DOACs increasing (from 3.0% to 18.0%) over time. Prior VKA therapy (n=209 (22.3%); adjusted ORs (aOR), 0.64; 95% CI, 0.49 to 0.84) and prior DOAC therapy (n=184 (25.7%); aOR, 0.64; 95% CI, 0.47 to 0.87) were independently associated with lower odds of favourable outcome compared with patients without anticoagulation (n=2037 (38.8%)). Prior VKA therapy (n=720 (49.4%); aOR, 1.71; 95% CI, 1.41 to 2.08) and prior DOAC therapy (n=460 (39.7%); aOR, 1.28; 95% CI, 1.02 to 1.60) were independently associated with higher odds of mortality compared with patients without anticoagulation (n=2512 (30.2%)).Conclusions The spectrum of anticoagulation-associated ICH changed over time. Compared with patients without prior anticoagulation, prior VKA treatment and prior DOAC treatment were independently associated with lower odds of favourable outcome and higher odds of mortality at 3 months. Specific reversal agents unavailable during the study period might improve outcomes of DOAC-associated ICH in the future.Data are available upon reasonable request. Anonymized data may be obtained upon reasonable request from any qualified investigator and after clearance by the local ethics committee and the steering committees from the Swiss and Norwegian Stroke Registries.