Patients with DOAC-associated intracranial hemorrhage had comparable in-hospital mortality (aOR 1.30; 95% CI 0.39-4.36; p=0.67) and 90-day functional outcomes compared to those using VKAs.
Cohort (n=171)
No
Does DOAC use compared to VKA use improve mortality and functional outcomes in patients with intracranial haemorrhage?
In patients with oral anticoagulant-associated intracranial haemorrhage, clinical outcomes and mortality were comparable between those taking DOACs and those taking VKAs.
Estimación del efecto: aOR 1.30 (95% CI 0.39-4.36)
valor p: p=0.67
Background: The clinical outcomes of patients with intracranial haemorrhage (ICH) whilst using direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) are uncertain. This study aimed to assess outcomes and management in patients receiving DOACs compared with those receiving VKAs. Methods: In this retrospective study, patients hospitalised during the period from 1 January 2017 to 31 December 2023 for traumatic and non-traumatic ICH and using oral anticoagulants (OACs) were included. The primary outcomes were mortality and functional outcomes, as measured by the modified Rankin Scale (mRS) during admission and 90-day follow-up. ICH management and complications were studied and compared between the two OAC groups. Results: A total of 171 eligible patients were included, comprising 24 patients on DOACs and 147 patients on VKAs. Patients receiving DOACs were older (79.1 vs. 66.8, p < 0.001) and had a higher proportion of traumatic ICH (75.0% vs. 46.3%, p = 0.009) than those receiving VKAs. In-hospital and 90-day outcomes were not statistically different between the two groups, with an adjusted odds ratio (aOR) of 1.30 (0.39–4.36) for in-hospital mortality, p = 0.67, and an aOR of 0.89 (0.33–2.41) for mRS 0–2 at 90 days, p = 0.83. In total, 81.3% of patients received at least one reversal agent; fresh frozen plasma was commonly used in the VKA group (78.9% vs. 33.3%, p < 0.001), whereas prothrombin complex concentrate was significantly prescribed in patients with DOAC-associated ICH (29.2% vs. 3.4%, p < 0.001). Conclusions: Patients with DOAC-associated ICH had comparable in-hospital and long-term clinical outcomes to those with VKA use.
Sathitwat et al. (Sat,) conducted a cohort in Intracranial haemorrhage (ICH) (n=171). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on In-hospital mortality (aOR 1.30, 95% CI 0.39-4.36, p=0.67). Patients with DOAC-associated intracranial hemorrhage had comparable in-hospital mortality (aOR 1.30; 95% CI 0.39-4.36; p=0.67) and 90-day functional outcomes compared to those using VKAs.
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