Intracerebral haemorrhage in patients taking different types of oral anticoagulants: a pooled individual patient data analysis from two national stroke registries

BackgroundWe 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.MethodsThis is an individual patient data study combining two prospective natio...

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Veröffentlicht in:	Stroke and vascular neurology Jg. 9; H. 6; S. 640 - 651
Hauptverfasser:	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
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	England BMJ Publishing Group Ltd 01.12.2024 BMJ Publishing Group LTD BMJ Publishing Group
Schlagworte:	Administration, Oral Aged Aged, 80 and over Anticoagulants Anticoagulants - administration & dosage Anticoagulants - adverse effects Cardiac arrhythmia Cardiovascular disease Cerebral Hemorrhage - chemically induced Cerebral Hemorrhage - mortality Data analysis Demographics Diabetes Factor Xa Inhibitors - administration & dosage Factor Xa Inhibitors - adverse effects Female Functional Status Heart attacks Hemorrhage Hospitals Humans Ischemia Male Medical history Middle Aged Mortality Neurosurgery Norway - epidemiology Original Research Patients Recovery of Function Registries Risk Assessment Risk Factors Statistical analysis Stroke Stroke - diagnosis Stroke - drug therapy Stroke - epidemiology Stroke - mortality Switzerland Time Factors Treatment Outcome Variables Vitamin K - antagonists & inhibitors Norway Switzerland Anticoagulants Hemorrhage Stroke
ISSN:	2059-8688, 2059-8696, 2059-8696
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Zusammenfassung:	BackgroundWe 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.MethodsThis 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.ResultsAmong 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%)).ConclusionsThe 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.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Additional supplemental material is published online only. To view, please visit the journal online (http://dx.doi.org/10.1136/svn-2023-002813). BMS and EF are joint first authors. OMR and DJS are joint senior authors. MBo: personal fees from AstraZeneca, a company that produces Andexanet alfa (a specific reversal agent for factor Xa-inhibitor-associated ICH, discussed in this study). SW: consultancy fees from Bayer, a company that produces Rivaroxaban (a DOAC discussed in this study). BV: personal fees from Pfizer AG/Bristol-Myers Squibb SA and Bayer AG, producesr of Apixaban and Rivaroxaban, two drugs discussed in this study. DJS: grants from Alexion/AstraZeneca, producer of andexanet alfa discussed in this study. Personal fees from Bayer, producer of Rivaroxaban, discussed in this study. Consultancy fees from VarmX (producer of VarmX, a compound under development for the treatment of FXaI-associated bleeding). All other authors have nothing to disclose. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
ISSN:	2059-8688 2059-8696 2059-8696
DOI:	10.1136/svn-2023-002813