Dataset Information

Restarting anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation: A nationwide retrospective cohort study.

ABSTRACT:

Background

Resuming anticoagulation after an intracranial hemorrhage (ICH) poses a clinical conundrum. The absence of relevant guidelines has led to wide variations in the decision on resuming anticoagulation therapies after ICH. This study aimed to evaluate the risks of an anticoagulation therapy on severe thrombotic events (STE) and severe hemorrhage events (SHE) in Korea and compare the effects of novel direct oral anticoagulants (NOACs) and warfarin in patients with AF.

Methods

This study was performed using the Korean national health insurance claims data obtained between 2002 and 2017 from individuals who had recently survived an ICH with comorbid AF. The endpoints of this study were STE and SHE. Anticoagulants, antiplatelet agents, and non-antithrombotic users were analyzed for survival with propensity score matching.

Results

Among the 4,964 participants analyzed, 878 (17.7%) and 2,070 (41.7%) used anticoagulant and antiplatelet agents, respectively. Anticoagulant (hazard ratio [HR] for STE: 0.385, P < 0.0001; HR for SHE: 0.578, P < 0.0001) or antiplatelet users (HR for STE: 0.545, P < 0.0001; HR for SHE: 0.637, P < 0.0001) had a lower risk of STE and SHE than non-antithrombotic users. Anticoagulation 6-8 weeks post-ICH showed a tendency of the lowest risk of all-cause mortality (HR: 0.614, P = 0.0552). However, there was no difference in the risk between the anticoagulant and antiplatelet users. Further, NOACs were associated with a lower risk of STEs than warfarin (HR, 0.263; P < 0.0001).

Conclusions

Our results showed that in patients with AF, resuming anticoagulants and antiplatelets after ICH improved the STEs and SHEs. Further, NOAC had additional benefits as compared to warfarin.

SUBMITTER: Moon JY

PROVIDER: S-EPMC9152296 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Restarting anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation: A nationwide retrospective cohort study.

Moon Jong Youn JY Bae Gi Hwan GH Jung Jaehun J Shin Dong Hoon DH

International journal of cardiology. Heart & vasculature 20220426

<h4>Background</h4>Resuming anticoagulation after an intracranial hemorrhage (ICH) poses a clinical conundrum. The absence of relevant guidelines has led to wide variations in the decision on resuming anticoagulation therapies after ICH. This study aimed to evaluate the risks of an anticoagulation therapy on severe thrombotic events (STE) and severe hemorrhage events (SHE) in Korea and compare the effects of novel direct oral anticoagulants (NOACs) and warfarin in patients with AF.<h4>Methods</h ...[more]

PMID: 35655532

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Project description:AbstractGlobally, 32% to 70% patients with atrial fibrillation (AF) are prescribed oral anticoagulants (OACs) with warfarin for stroke prevention. However, patients with AF on OACs may experience intracranial hemorrhage (ICH), which presents a treatment dilemma. We therefore investigated whether resuming OACs in these patients is beneficial. Electronic medical records of patients with AF on OACs discharged with ICH between 2001 and 2013 were retrieved from the Taiwan National Health Insurance Research Database for analysis. We excluded patients who were <20 years old, who were not using OACs 6 months prior to ICH, or who had a CHA2DS2-VASc score of ≤1. We also excluded patients who died during admission for ICH, with follow-up for <6 weeks after discharge, or who started OAC >6 weeks after ICH diagnosis. The remaining patients were categorized into those who resumed OAC and those who discontinued OAC. Propensity score matching was performed between the 2 groups. Primary outcomes were mortality/ischemic stroke (IS)/systemic embolism (SE), IS/SE, and recurrent ICH at 6 months and 1 year. After the exclusion criteria were applied, 604 eligible patients (408 discontinued OAC and 196 resumed OAC within 6 weeks) were included in this study, and 186 patients in each group were 1:1 matched. Patients who resumed OAC had significantly lower mortality/IS/SE (hazard ratio [HR] = 0.39, 95% confidence interval [CI] = 0.20-0.76) and IS/SE (HR = 0.12, 95% CI = 0.03-0.53) at 6-month follow-up than patients who discontinued OAC. In addition, patients who resumed OAC had significantly lower mortality/IS/SE (HR = 0.56, 95% CI = 0.34-0.93) and IS/SE (HR = 0.26, 95% CI = 0.09-0.75) at 1-year follow-up. No difference in recurrent ICH was noted between the 2 groups. In conclusion, in patients with AF on OACs with ICH, resuming anticoagulant use was associated with significantly lower risks of composite outcomes of mortality/IS/SE and IS/SE than patients who discontinued OACs. No difference in recurrent ICH was observed between the 2 groups.

Dataset Information

Restarting anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation: A nationwide retrospective cohort study.

Background

Methods

Results

Conclusions

Publications

Restarting anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation: A nationwide retrospective cohort study.

Similar Datasets

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