Medicina clinica · 2025
Impact of restarting anticoagulation on the outcome of patients with intracerebral hemorrhage and atrial fibrillation.
СтатьяНазвание и аннотация: Перевод в очереди
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Úriz Óscar, García Pastor Andrés, Iglesias Mohedano Ana María, Díaz Otero Fernando, Vázquez Alén Pilar, Fernández Bullido Yolanda, Vales Montero Marta, Gil Núñez Antonio Carmelo
Аннотация
INTRODUCTION: The management of patients with atrial fibrillation (AF) after an intracerebral haemorrhage (ICH) is controversial. We analysed the cumulative rates of ICH, ischaemic stroke (IS) and mortality in a cohort of patients with ICH+AF and compared them according to the treatment chosen.
METHODS: Retrospective single-centre study of patients with ICH+AF. Patients were classified into two groups: «no anticoagulation restart» (non-AR) and «anticoagulation restart» (AR). The primary endpoint was the cumulative rate of ICH, IS, any intra/extracranial bleeding (AB), any ischaemic or haemorrhagic event (AE) or death during 2years of follow-up.
RESULTS: 117 patients included; non-AR group, 63 patients (53.8%); AR: 54 (46.5%). Mean age 79.4years (SD: 7.9), 73 males (62.4%). No significant differences in baseline characteristics were observed between the two groups. Mortality (30days after ICH) was 31.8% and higher in non-AR vs AR group: 48% vs 19.5% (P=.001). The cumulative ICH rate was 10.9% and AB 18%, with no difference between AR and non-AR. The IS rate was 8.3%, higher in the non-AR group (18.1 vs 2.1%, P=.010). The AE rate was 25.4% and higher in the non-RA group (35.9% vs. 17.7%, P=.022). Non-AR was an independent factor for increased risk of death (HR: 5.38; 95%CI: 2.30-12.56) and AE (HR: 6.16; 95%CI: 1.87-20.25).
CONCLUSIONS: Patients with ICH+AF are at an increased risk of death or IS or new ICHs. AR does not increase the risk of rebleeding while non-AR is associated with an increased risk of IS and death.
METHODS: Retrospective single-centre study of patients with ICH+AF. Patients were classified into two groups: «no anticoagulation restart» (non-AR) and «anticoagulation restart» (AR). The primary endpoint was the cumulative rate of ICH, IS, any intra/extracranial bleeding (AB), any ischaemic or haemorrhagic event (AE) or death during 2years of follow-up.
RESULTS: 117 patients included; non-AR group, 63 patients (53.8%); AR: 54 (46.5%). Mean age 79.4years (SD: 7.9), 73 males (62.4%). No significant differences in baseline characteristics were observed between the two groups. Mortality (30days after ICH) was 31.8% and higher in non-AR vs AR group: 48% vs 19.5% (P=.001). The cumulative ICH rate was 10.9% and AB 18%, with no difference between AR and non-AR. The IS rate was 8.3%, higher in the non-AR group (18.1 vs 2.1%, P=.010). The AE rate was 25.4% and higher in the non-RA group (35.9% vs. 17.7%, P=.022). Non-AR was an independent factor for increased risk of death (HR: 5.38; 95%CI: 2.30-12.56) and AE (HR: 6.16; 95%CI: 1.87-20.25).
CONCLUSIONS: Patients with ICH+AF are at an increased risk of death or IS or new ICHs. AR does not increase the risk of rebleeding while non-AR is associated with an increased risk of IS and death.