Inohara T, et al. - This research was executed in order to inspect the tie-up between preceding oral anticoagulant use (warfarin, non–vitamin K antagonist oral anticoagulants (NOACs), and no oral anticoagulants [OACs]) and in-hospital mortality among patients with intracerebral hemorrhage (ICH). Data shed light on the interconnection between prior use of NOACs or warfarin with higher in-hospital mortality compared with no OACs in the study cohort. Furthermore, prior use of NOACs was related to a lower risk of in-hospital mortality when compared to prior use of warfarin.

Methods

• The design of this research was a retrospective cohort study.
• The eligible candidates included 141,311 patients with ICH admitted from October 2013 to December 2016 to 1,662 Get With The Guidelines–Stroke hospitals.
• Anticoagulation therapy before ICH, defined as any use of OACs within 7 days prior to hospital arrival was served as the exposure.
• The primary measure included in-hospital mortality.

Results

• A total of 15,036 (10.6%) enrollees were taking warfarin and 4,918 (3.5%) were taking NOACs preceding ICH, and 39,585 (28.0%) and 5,783 (4.1%) were taking concomitant single and dual antiplatelet agents, respectively, among 141,311 patients with ICH (mean [SD] age, 68.3 [15.3] years; 48.1% women).
• It was found that individuals with prior use of warfarin or NOACs appeared to be older and exhibited a higher prevalence of atrial fibrillation and prior stroke.
• No notable variation was observed across the 3 groups (median, 9 [interquartile range, 2-21] for warfarin, 8 [2-20] for NOACs, and 8 [2-19] for no OACs) in the acute ICH stroke severity (measured by the National Institutes of Health Stroke Scale).
• Data revealed that the unadjusted in-hospital mortality rates were 32.6% for warfarin, 26.5% for NOACs, and 22.5% for no OACs.
• In contrast to the patients without prior use of OACs, higher risk of in-hospital mortality was found among patients with prior use of warfarin (adjusted risk difference [ARD], 9.0% [97.5% CI, 7.9% to 10.1%]; adjusted odds ratio [AOR], 1.62 [97.5% CI, 1.53 to 1.71]) and it was higher among patients with prior use of NOACs (ARD, 3.3% [97.5% CI, 1.7% to 4.8%]; AOR, 1.21 [97.5% CI, 1.11-1.32]).
• As per a comparison with patients with prior use of warfarin, patients with prior use of NOACs demonstrated a lower risk of in-hospital mortality (ARD, -5.7% [97.5% CI, -7.3% to -4.2%]; AOR, 0.75 [97.5% CI, 0.69 to 0.81]).
• A numerically greater variation was brought to light in the mortality between NOAC-treated patients and warfarin-treated patients among patients with prior use of dual antiplatelet agents (32.7% vs 47.1%; ARD, -15.0% [95.5% CI, -26.3% to -3.8%]; AOR, 0.50 [97.5% CI, 0.29 to 0.86]) when compared to those taking these agents without prior antiplatelet therapy (26.4% vs 31.7%; ARD, -5.0% [97.5% CI, -6.8% to -3.2%]; AOR, 0.77 [97.5% CI, 0.70 to 0.85]).
• Nonetheless, the interaction P value (.07) was not discovered to be statistically prominent.