Intracerebral haemorrhage in patients taking different types of oral anticoagulants: a pooled individual patient data analysis from two national stroke registries.
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Siepen Bernhard M, Forfang Elisabeth, Branca Mattia, Drop Boudewijn, Mueller Madlaine, Goeldlin Martina B, Katan Mira, Michel Patrik, Cereda Carlo, Medlin Friedrich, Peters Nils, Renaud Susanne, Niederhauser Julien, Carrera Emmanuel, Kahles Timo, Kägi Georg, Bolognese Manuel, Salmen Stephan, Mono Marie-Luise, Polymeris Alexandros A, Wegener Susanne, Z'Graggen Werner, Kaesmacher Johannes, Schaerer Michael, Rodic Biljana, Kristoffersen Espen Saxhaug, Larsen Kristin T, Wyller Torgeir Bruun, Volbers Bastian, Meinel Thomas R, Arnold Marcel, Engelter Stefan T, Bonati Leo H, Fischer Urs, Rønning Ole Morten, Seiffge David J
Аннотация
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.