Abstract Number: PB2069
Meeting: ISTH 2020 Congress
Background: Intracerebral hemorrhage (ICH) is associated with severe prognosis and recurrent risk. This risk impacts on the decision to resume anticoagulation in patients with atrial fibrillation (AF) or venous thromboembolism (VTE).
Aims: To evaluate the incidence rate of recurrent ICH in patients with AF or VTE resuming anticoagulation after a first episode of ICH.
Methods: We report data of two cohorts of patients who started anticoagulants for AF or VTE after the occurrence of a first ICH. The VKA cohort of 166 patients derives from the CHIRONE Study and includes AF and VTE patients on VKAs, the DOAC cohort of 178 patients derives from the START2-Register and includes AF and VTE patients on DOACs.
Results: The clinical characteristics of the two cohort are similar with the exception of more prevalence of history of previous stroke/TIA in DOAC patients in DOAC patients with respect to VKA patients (p=0.02)) and of levels of serum creatinine >1.5 mg/dL in VKA patients with respect to DOAC patients (p=0.0001).
The index ICH was spontaneous in 66.4% among DOAC cohort and in 33.7% among VKAs cohort (p=0.0001). During follow-up, 14 recurrent ICH were recorded; 9 (rate 2.5 x 100 patient-years) in VKA cohort and 5 (rate 1.3 x 100 patient-years) in DOAC cohort (Relative Risk 1.9; 95% CI 0.6-7.4; p=0.2).
The univariate logistic regression analysis including both cohorts showed that patients with recurrent ICH were more frequently males, hypertensive, with a history of previous Stroke/TIA and older than patients without recurrence. None of these differences reached statistical significance. VKA patients showed a higher (but not statistically significant) risk of recurrence with respect to DOAC patients (OR 1.9) (95% CI 0.7-6.7; p=0.2).
Conclusions: A trend toward fewer ICH recurrences was detected among patients who resumed DOACs after ICH in comparison to the previously reported rate of patients on warfarin.
To cite this abstract in AMA style:Poli D, Antonucci E, Vignini E, Martinese L, Testa S, Guazzaloca G, Simioni P, Pengo V, Pignatelli P, Falanga A, Masciocco L, Barcellona D, Ciampa A, Chiarugi P, Paparo C, Bucherini E, Marzolo M, Ageno W, Palareti G. Anticoagulation Resumption After Intracerebral Hemorrhage in Two Cohorts of Patients Treated with Vitamin K Antagonists and Direct Oral Anticoagulants [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/anticoagulation-resumption-after-intracerebral-hemorrhage-in-two-cohorts-of-patients-treated-with-vitamin-k-antagonists-and-direct-oral-anticoagulants/. Accessed January 23, 2022.
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