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