ICH in Patients Taking NOACs vs. Warfarin and Mortality Risk

Study Questions:

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.

Clinical Topics: Anticoagulation Management, Prevention

Keywords: Anticoagulants, Cerebral Hemorrhage, Hemorrhage, Hospital Mortality, Intracranial Hemorrhages, Primary Prevention, Stroke, Thromboembolism, Vitamin K, Warfarin

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