Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin

Abstract

ObjectivesThis cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)–associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database.MethodsWe analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC- and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge.ResultsDOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039).ConclusionsThis nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.

Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

“…2018) recently reported no difference in 3-month functional outcome and mortality between NOAC-ICH (n = 291) and VKA-ICH (n = 831). 20 Furthermore, some smaller studies reported less hematoma expansion in NOAC-ICH than in VKA-ICH. 20 Furthermore, some smaller studies reported less hematoma expansion in NOAC-ICH than in VKA-ICH.…”

“…15 In contrast, some studies in Japanese populations have reported superior survival in NOAC-ICH compared to VKA-ICH, [16][17][18][19] including a multicenter study with 227 patients on NOAC and 2018 on VKA. 20 Furthermore, some smaller studies reported less hematoma expansion in NOAC-ICH than in VKA-ICH. 14,16,21,22 Another observational study performed in the UK reported superior 3-month functional outcome in NOAC patients compared to VKA.…”

Coagulopathy reversal in intracerebral haemorrhage

“…There were no significant differences between the two groups 16. Other studies have shown similar functional outcomes in patients with ICH receiving VKA and DOACs and also mortality benefit in patients on DOACs 17 18…”

A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

“…Patients with DOAC-associated ICH were less likely to suffer moderately or severely impaired consciousness (31.3% vs. 39.4%; P = 0.002) or require surgical intervention (5.3% vs. 9.9%; P = 0.024). The ICH associated with DOAC also had a lower mortality rate [28]. Caughey et al, analyzed the reporting of spontaneous adverse events (SAE) associated with apixaban use in Australia, Canada, and the United States.…”