Time trends in intracranial bleeding associated with direct oral anticoagulants: a 5-year cohort study

Hogg, Kerstin; Bahl, Bharat; Latrous, Meriem; Argentina, Sarina Scaffidi; Thompson, Jesse; Chatha, Aasil Ayyaz; Castellucci, Lana A; Stiell, Ian G.

doi:10.9778/cmajo.20150037

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…Within our study population, cases of OAC-ICH accounted for 14.4% of total ICHs. Overall, we recorded a slightly lower frequency of OAC-ICH compared to prior population-based studies 7,9,22,23 in which OAC-ICHs exceeded 20% of all cases. This discrepancy might reflect lower use or adherence to OACs compared to other settings or differences in management of concomitant risk factors concurring in the development of ICH (e.g.…”

Section: Discussioncontrasting

confidence: 68%

“…Indeed, some population-based studies have pointed out a noticeable rise in the global incidence of ICH related to OAC use (OAC-ICH), potentially due to increased DOACs utilization. 6,7 Conversely, some population and hospital-based studies showed a decrease in both total ICH and OAC-ICH incidence over the more recent years. [8][9][10] In addition, the increased usage of OACs might not only elevate the number of incident events but also impact on prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology and outcomes of intracerebral hemorrhage associated with oral anticoagulation over 10 years in a population-based stroke registry

Gabriele,

Foschi,

Conversi

et al. 2023

International Journal of Stroke

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Background: Recent years have seen a change in the use of anticoagulants in the general population due to the availability of direct oral anticoagulants (DOACs) as an alternative to vitamin K antagonists (VKAs) and increased detection of atrial fibrillation. It is important to have updated epidemiological data to understand how this change is impacting on the occurrence and outcome of intracerebral hemorrhage (ICH). Patients and methods: Our prospective population-based registry included patients with first-ever ICH occurring from January 2011 to December 2020. Oral anticoagulants (OAC)-related ICH was defined as an ICH occurring within 48 h from the intake of DOAC or VKAs, regardless of the measured international normalized ratio on hospital admission. Results: We included 748 first-ever ICH, of whom 108 (14.4%) were OAC-related. Specifically, 75 (69.4%) ICHs occurred on VKA and 33 (30.6%) on DOAC. The incidence of oral anticoagulation-associated intracerebral hemorrhage (OAC-ICH) was stable over time (p = 0.226). Among OAC-ICHs, we observed an increase in the overall incidence of DOAC-ICH (p for trend < 0.001) which overcome that of VKA-ICH in 2020 (incidence rate ratio (IRR) 4.71, 95% confidence interval (CI): 1.22–33.54; p = 0.022). Patients with OAC-ICH showed higher 30-day case fatality rates than those with non-OAC-ICH (48.1% vs 34.1%; p = 0.007). Conclusion: No changes over time were detected in the incidence of OAC-ICH, but throughout the study period, there was a change in OAC-ICH from mostly VKA-related to mostly DOAC-related. Mortality in patients with OAC-ICH was higher than in patients with non-OAC-ICH.

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Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Epidemiology and outcomes of intracerebral hemorrhage associated with oral anticoagulation over 10 years in a population-based stroke registry

Gabriele,

Foschi,

Conversi

et al. 2023

International Journal of Stroke

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“…Given the progressive increase in OAC prescription and despite this shift from AVK to more safe drugs, it is not surprising that ICH-OAC has increased in the last years [27]. However, there is no study on OAC prescription in our country.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background: Intracerebral hemorrhage (ICH) is 7- to 10-fold higher in anticoagulated patients. Given the more extended use of oral anticoagulants, an increase in the prevalence of ICH associated with oral anticoagulation (ICH-OAC) could be expected. However, there is no previous study that assesses the time trends of ICH-OAC in Spain. Methods: We conducted a combined data analysis after creating a joint database of the 3 most important epidemiological studies on ICH-OAC of our country: the EPICES study (2008–2009), the TAC Registry (TR) study (2012–2013) and the TAC Registry 2 (TR2) study (2015). We finally included 65, 235, and 366 patients from the EPICES, TR, and TR2 studies, respectively. Results: We have observed a 3.73-fold increase in the crude annual incidence of ICH-OAC throughout the period of study, with proportion of ICH-OAC out of total ICH increasing from 8.4% in 2008 to 18.2% in 2015. Age, dyslipidemia, and prior antiplatelet treatment increased during the study, but we found no statistically significant differences in other risk factors for ICH-OAC. Conclusions: The incidence of ICH-OAC is increasing in our country. It might at least be partly explained by aging of the population, with mean age at presentation being higher in the last years.

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“…The ARISTOTLE clinical trial demonstrated that in AF patients, efficacy and safety of apixaban was better than those of warfarin, which has been the most commonly used anticoagulant therapy . Therefore, the number of prescriptions for direct FXa inhibitors such as apixaban and rivaroxaban are tending to increase while the number of prescriptions for warfarin have decreased . However, the apixaban package insert indicates that there is no way to adjust its dosage according to monitoring anticoagulant activities such as prothrombin time (PT), international normalized ratio of PT (PT‐INR), and anti‐FXa activity because, unlike warfarin, the apixaban therapeutic window remains unclear .…”

Section: Introductionmentioning

confidence: 99%

Population pharmacokinetics and pharmacogenomics of apixaban in Japanese adult patients with atrial fibrillation

Ueshima

Hira

Kimura

et al. 2018

Brit J Clinical Pharma

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Time trends in intracranial bleeding associated with direct oral anticoagulants: a 5-year cohort study

Cited by 8 publications

References 16 publications

Epidemiology and outcomes of intracerebral hemorrhage associated with oral anticoagulation over 10 years in a population-based stroke registry

Epidemiology and outcomes of intracerebral hemorrhage associated with oral anticoagulation over 10 years in a population-based stroke registry

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

Population pharmacokinetics and pharmacogenomics of apixaban in Japanese adult patients with atrial fibrillation

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