The objective of a study was to determine whether oral anticoagulation treatment ( OAT ) resumption after primary intracerebral hemorrhage ( ICH ) is associated with long-term outcome.
Oral anticoagulation treatment resumption is a therapeutic dilemma in post-ICH care, particularly for lobar hemorrhages related to cerebral amyloid angiopathy. However, the impact of ICH location on functional outcome after oral anticoagulation treatment resumption has not been explored.
Researchers meta-analyzed individual patient data from: 1) a multi-center OAT-ICH study conducted in Germany ( n=542 ); 2) a longitudinal primary ICH study conducted in Boston, US ( n=268 ); 3) the multi-center Ethnic/Racial Variations of Intracerebral Hemorrhage ( ERICH ) study (n=217).
They determined whether, at one year from index ICH, oral anticoagulation treatment resumption was associated with: 1) mortality and 2) favorable functional outcome ( modified Rankin Scale [ mRS ] 0-3 ).
Researchers have separately analyzed non-lobar and lobar ICH cases using multivariable ( Cox regression ) models, adjusting for ICH volume, discharge mRS, CHADS2 and HAS-BLED scores.
641 non-lobar OAT-ICH and 386 lobar OAT-ICH survivors were included.
Among non-lobar ICH survivors 179/641 ( 28% ) resumed oral anticoagulation treatment, while 88/386 ( 23% ) lobar ICH survivors did.
ICH volume, CHADS2 and HAS-BLED scores were not associated with oral anticoagulation treatment resumption in either lobar or non-lobar ICH ( all p more than 0.20 ).
Discharge mRS was associated with oral anticoagulation treatment resumption in lobar ICH only ( OAT: median 3.5, Inter-Quartile Range [ IQR ] 3-5; no OAT: median 4.0, IQR 3-5; p=0.011 ).
In multivariable analyses oral anticoagulation treatment resumption after non-lobar ICH was associated with decreased mortality ( hazard ratio, HR=0.22, 95% Confidence Interval [ CI ]=0.16-0.30, p less than 0.0001 ) and improved functional outcome ( HR=5.12, 95% CI=3.86-6.80, p less than 0.0001 ) at one year.
Oral anticoagulation treatment resumption after lobar ICH was associated with decreased mortality ( HR=0.25, 95% CI=0.17-0.38, p less than 0.0001 ) and favorable functional outcome ( HR=4.89, 95% CI=3.25-7.36, p less than 0.0001 ).
In conclusion, oral anticoagulation treatment resumption was associated with decreased mortality and favorable outcome after both non-lobar and lobar ICH.
These findings support conducting randomized clinical trials to explore risks and benefits of oral anticoagulation treatment resumption after ICH. ( Xagena )
Biffi et al, International Stroke Conference, 2017