ICH in Patients Taking NOACs vs. Warfarin and Mortality Risk
Are patients with intracerebral hemorrhage (ICH) and preceding warfarin anticoagulation more likely to die in the hospital than patients with ICH and preceding non–vitamin K antagonist anticoagulation (NOAC)?
This is a retrospective cohort study of patients with a diagnosis of ICH between October 2013 and December 2016, who were admitted to a hospital that participates in the Get With The Guidelines-Stroke registry. Preceding use of anticoagulation with warfarin or a NOAC was recorded. The outcome of interest was in-hospital mortality (yes or no).
Of the 141,311 patients with ICH, 85.9% were not receiving anticoagulation prior to ICH, 10.6% were receiving warfarin, and 3.5% were receiving a NOAC. After adjustment for numerous potential confounders, a 25% lower odds of in-hospital mortality was observed for patients on a NOAC compared to patients on warfarin (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.69-0.81). Compared to patients on no anticoagulation, patients on a NOAC had higher odds of in-hospital mortality (aOR, 1.21; 95% CI, 1.11-1.32), as did patients on warfarin (aOR, 1.62; 95% CI, 1.53-1.71).
Warfarin and NOAC use prior to ICH were both associated with increased odds of in-hospital mortality compared with no anticoagulation. However, the odds of mortality were lower for patients on a NOAC compared to patients on warfarin.
Evidence suggests that NOACs are associated with a lower odds of ICH compared to warfarin. The current study suggests that – when ICH does occur – NOACs are associated with a lower risk of in-hospital mortality than warfarin. These findings contribute to the growing body of evidence that NOACs may be a safer option than warfarin for the prevention of thromboembolic disease.
Keywords: Anticoagulants, Cerebral Hemorrhage, Hemorrhage, Hospital Mortality, Intracranial Hemorrhages, Primary Prevention, Stroke, Thromboembolism, Vitamin K, Warfarin
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