Mortality Linked to Prior Oral Anticoagulant Use in Patients With Intracerebral Hemorrhage

MRI OF THE BRAIN AND MRA & MRV OF THE BRAIN.Moderate perilesional vasogenic edema with 0.7 cm midline shift to the left side.
This study evaluated the association between prior oral anticoagulant use and in-hospital outcomes among patients with nontraumatic intracerebral hemorrhage.

Factor Xa (FXa) inhibitor-associated intracerebral hemorrhage (ICH) was associated with adverse outcomes including mortality or transfer to hospice according to results of a cohort study published in JAMA Network Open.

Researchers analyzed data from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke (GWTG-Stroke) registry. Patients (N=219,701) with subarachnoid hemorrhage, subdural hematoma, or on dabigatran between 2013 and 2018 at 1870 hospitals were assessed for clinical outcomes.

Patients were on FXa inhibitors (n=9202), warfarin (n=21,430), or no oral anticoagulants (OAC; n=189,069) prior to nontraumatic ICH. Patient groups were aged median 77 (interquartile range [IQR], 70-84), 77 (IQR, 69-84), and 68 (IQR, 56-79) years; 49.0%, 46.3%, and 47.9% were women; and 78.6%, 76.9%, and 59.6% were White, respectively. Patient group differed significantly for all demographic and clinical characteristics.

Compared with no OAC, increased risk for in-hospital mortality was associated with warfarin (adjusted odds ratio [aOR], 1.67; 95% CI, 1.60-1.74; P <.001) and FXa inhibitors (aOR, 1.27; 95% CI, 1.20-1.34; P <.001) as was death or discharge to hospice with warfarin (aOR, 1.50; 95% CI, 1.44-1.56; P <.001) and FXa inhibitors (aOR, 1.19; 95% CI, 1.13-1.26; P <.001).

Compared with warfarin, patients on FXa inhibitors were associated with a decreased risk for in-hospital mortality (aOR, 0.76; 95% CI, 0.72-0.81; P <.001) and death or discharge to hospice (aOR, 0.79; 95% CI, 0.75-0.84; P <.001).

Although FXa inhibitors had a lower risk for mortality compared with warfarin, 27.0% of patients with FXa inhibitor-associated ICH died during hospitalization.

Among patients on warfarin, those with dual-or single antiplatelet agents were associated with increased in-hospital mortality (dual: aOR, 2.07; 95% CI, 1.72-2.50; P <.001; single: aOR, 1.16; 95% CI, 1.09-1.24; P <.001) and death or discharge to hospice (dual: aOR, 1.86; 95% CI, 1.54-2.26; P <.001; single: aOR, 1.13; 95% CI, 1.06-1.21; P <.001).

This study may have been limited by its unbalanced patient cohorts.

The study authors concluded FXa inhibitor-associated ICH was a devastating complication and additional studies of treatment strategies are needed.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Xian Y, Zhang S, Inohara T, et al. Clinical characteristics and outcomes associated with oral anticoagulant use among patients hospitalized with intracerebral hemorrhage. JAMA Netw Open. 2021;4(2):e2037438. doi:10.1001/jamanetworkopen.2020.37438