Epidemiology of Intracranial Hemorrhage Associated with Oral Anticoagulants in Spain: Trends in Anticoagulation Complications Registry – The TAC 2 Study

Abstract

Objective: Patients receiving treatment with oral anticoagulants (OACs) are at risk of intracranial hemorrhage (ICH). In this study, we describe the epidemiological and clinical characteristics of patients receiving OACs who experience ICH and compare those receiving vitamin K antagonists (ICH-VKAs) with those receiving direct OACs (ICH-DOACs). Methods: We performed a national, multicenter, descriptive, observational, retrospective study of all adult patients receiving OACs who were admitted to the neurology department with ICH over a 1-year period. The study population was divided into 2 groups (ICH-VKAs and ICH-DOACs). Epidemiological, clinical, radiological, and therapy-related variables, as well as functional outcome, were compared at 3 months. A total of 366 cases were included (331 ICH-VKAs, 35 ICH- DOACs). Results: The crude annual incidence of OAC-induced ICH was 3.8 (95% CI, 2.78–3.41) per 100,000 inhabitants/year. The mean (± SD) age was greater for ICH-DOACs (81.5 ± 8.3 vs. 77.7 ± 8.3 years; p = 0.012). The median (IQR) volume of the hemorrhage was lower for ICH-DOACs (11 [30.8] vs. 25 [50.7] mL; p = 0.03). The functional independence rate at 3 months (modified Rankin Scale, mRS < 3) was similar in both groups, although stroke-related mortality was greater in ICH-VKAs (40 vs. 72.7%; p = 0.02). The most frequently indicated poststroke antithrombotic therapy was DOACs (38.7%). Conclusion: We found that the incidence of OAC-induced ICH was greater than in previous studies. Hemorrhage volume and mortality were lower in ICH-DOACs than in ICH-VKAs. After stroke, DOACs were the most frequently indicated antithrombotic treatment.

Time Trends in Intracerebral Hemorrhage Associated with Oral Anticoagulation and Its Risks Factors in Spain from 2008 to 2015

“…Moreover, the proportion of ICH-OAC out of the total ICH increased each year from 2005 to 2008 in the USA, up to 7.3% in 2008 [13]. That proportion was similar to the contemporary ones of Spain reflected in a local study of Barcelona [3] (time frame 1995–2003, with a 6.5%) and the EPICES study (8.4%) and that have continued to increase according to the 13.6% in the TR1 and the 18.2% in the TR2 studies [1, 10, 14]. The increase in the relative incidence of ICH-OAC out of the total hospitalizations for ICH might just reflect a decrease in ICH associated with other risk factors and etiologies of bleeding.…”

“…The TAC registry 2 (TR2) study [10] was methodically comparable to the former, but it was performed during 2015 and included also the DOAC. The main objective of this study was to compare epidemiological, clinical, radiological, and therapy-related variables, as well as functional outcome at 3 months between ICH-VKA and ICH-DOAC.…”

Intracranial hemorrhage with direct oral anticoagulants in patients with brain metastases

“…The overall 12month mortality was high and comparable between the 2 groups, whereas ICH-related fatalities only occurred in the LMWH group (3 of 55; 5.5%). While in noncancer patients with ICH, mortality is reduced with DOACs compared with vitamin K antagonists, 22,23 reduced ICH-related mortality with DOACs remains to be demonstrated in this context.…”

Oral Anticoagulant Use by Emergency Medical Services Patients in the United States

“…These observations highlight the prevalence of OAC use among EMS patients and are particularly important given the increasing prevalence of OAC use internationally. 6–8,10,11…”

“…6 Oral anticoagulant use is increasing internationally. 6–11 A major pitfall of OACs is that their use increases the risk of serious bleeding, including life-threatening hemorrhage. 6 Given EMS’s role in the emergent treatment of hemorrhage, knowledge of a patient’s OAC use history is essential, potentially influencing prehospital care and outcomes.…”