Mortality related to previous oral anticoagulant use in patients with intracerebral haemorrhage

Factor Xa (FXa) inhibitor-associated intracerebral hemorrhage (ICH) was associated with adverse outcomes, including mortality or transmission to the hospice, according to the results of a cohort study published on JAMA Network Open.

The researchers analyzed data from the registry of the American Heart Association and the American Stroke Association (Get With The Guidelines-Stroke) (GWTG-Stroke). Patients (N = 219,701) with subarachnoid hemorrhage, subdural hematoma, or dabigatran between 2013 and 2018 in 1,870 hospitals were examined for clinical results.

Patients received prior non-traumatic ICH FXa inhibitors (n = 9202), warfarin (n = 21,430), or no oral anticoagulants (OAC; n = 189,069). The median patient groups were 77 years old (interquartile range) [IQR]70-84), 77 (IQR, 69-84) and 68 (IQR, 56-79) years; 49.0%, 46.3%, and 47.9% were women; and 78.6%, 76.9% and 59.6% were white, respectively. The patient group differed significantly for all demographic and clinical characteristics.

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An increased risk of in-hospital mortality was associated with warfarin compared to no OAC (adjusted odds ratio) [aOR]1.67; 95% CI, 1.60-1.74; P <0.001) and FXa inhibitors (aOR 1.27; 95% CI 1.20-1.34; P <0.001) as well as death or discharge to the hospice with warfarin (aOR 1.50; 95% CI 1.44 -1.56; P <) 0.001) and FXa inhibitors (aOR 1.19; 95% CI 1.13-1.26; P <0.001).

Compared to warfarin, patients with FXa inhibitors were at a reduced risk of hospitalized mortality (aOR, 0.76; 95% CI, 0.72-0.81; P <0.001) and death or discharge to the hospice (aOR , 0.79; 95%) associated CI 0.75-0.84; P <0.001).

Although FXa inhibitors had a lower risk of mortality compared to warfarin, 27.0% of patients with FXa inhibitor-associated ICH died during hospitalization.

Among warfarin patients, patients with two or single platelet aggregation inhibitors were associated with increased hospital mortality (dual: aOR 2.07; 95% CI 1.72-2.50; P <0.001; single: aOR 1.16; 95% CI) 1.09-1.24; P <0.001) and death or discharge to the hospice (dual: aOR 1.86; 95% CI 1.54-2.26; P <0.001; single: aOR 1.13; 95% CI 1.06-1, 21; P <0.001).

This study may have been limited by the unbalanced patient cohorts.

The study’s authors concluded that FXa inhibitor-associated ICH is a devastating complication and additional studies on treatment strategies are needed.

Disclosure: Several authors have stated that they are part of the pharmaceutical industry. For a full list of details, see the original article.


Xian Y. Zhang S. Inohara T. et al. Clinical features and results associated with the oral use of anticoagulants in hospitalized patients with intracerebral haemorrhage. JAMA Netw Open. 2021; 4 (2): e2037438. doi: 10.1001 / jamanetworkopen.2020.37438

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