Clinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage

Importance Although the use of factor Xa (FXa) inhibitors has increased substantially over the past decade, there are limited data on characteristics and outcomes of FXa inhibitor–associated intracerebral hemorrhage (ICH). Objective To investigate the association between prior oral anticoagulant use (FXa inhibitors, warfarin, or none) and in-hospital outcomes among patients with nontraumatic ICH. Design, Setting, and Participants This is a cohort study of 219 701 patients with nontraumatic ICH admitted to 1870 hospitals in the Get With The Guidelines–Stroke registry between October 2013 and May 2018. Data analysis was performed in December 2019. Exposures Anticoagulation therapy before ICH. Main Outcomes and Measures The primary outcome was in-hospital mortality. Secondary outcomes were a composite measure of in-hospital mortality or discharge to hospice, discharge home, independent ambulation, and modified Rankin Scale (mRS) score at discharge. Results Of 219 701 patients (mean SD age, 68.2 15.3 years; 104 940 women 47.8%), 9202 (4.2%) were taking FXa inhibitors, 21 430 (9.8%) were taking warfarin, and 189 069 (86.0%) were not taking any oral anticoagulant before ICH. Patients taking FXa inhibitors or warfarin were older and had higher prevalence of cardiovascular risk factors. Compared with those not taking an oral anticoagulant (42 660 of 189 069 patients 22.6%), the in-hospital mortality risk was higher for both FXa inhibitors (2487 of 9202 patients 27.0%; adjusted odds ratio aOR, 1.27; 95% CI, 1.20-1.34;P P P P P PPPP Conclusions and Relevance In this cohort study, FXa inhibitor–associated ICH was associated with higher risk of mortality or death or discharge to hospice than not taking an oral anticoagulant, but patients taking FXa inhibitors had better outcomes than those with warfarin-related ICH.