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May 8, 2026European Stroke JournalOpen Access

Anticoagulation reversal in OAC-related ICH linked to ~68% lower 24-hour mortality.

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Why the study?

Despite guideline recommendations, anticoagulation reversal is inconsistently used in oral anticoagulant-related intracerebral hemorrhage, particularly in severe presentations.

Does anticoagulation reversal reduce mortality in patients with oral anticoagulant-related intracerebral hemorrhage?

Population

891 consecutive OAC-related ICH patients admitted to 18 Spanish stroke centers

Comparison

Anticoagulation reversal vs no reversal

Design

Prospective multicenter registry study

Follow-up

90 days

Key result

Anticoagulation reversal in OAC-related intracerebral hemorrhage was independently associated with lower 24-hour (aOR 0.32; 95% CI 0.18-0.56) and 90-day mortality (aOR 0.59; 95% CI 0.35-0.99).

Authors

DRDavid Rodriguez-LunaOPOlalla PancorboAGAna Nuñez Guillen

Discussion

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Member takes

Overview

Reversal in DOAC-ICH was associated with better outcomes; reinforces ESO guidelines and extends adjusted real-world evidence.**[[1]](https://pmc.ncbi.nlm.nih.gov/articles/PMC6921939/)[[2]](https://journals.sagepub.com/doi/abs/10.

Key Points

  • The study aims to identify factors affecting the administration of anticoagulation reversal and its association with mortality in patients with OAC-related ICH.
  • Prospective analysis of 891 patients with OAC-related ICH from the ARICH registry across 18 Spanish stroke centers.
  • Evaluation of reversal administration, 24-hour, and 90-day mortality with hierarchical mixed-effects regression models.
  • Post-hoc mortality analysis in patients with severe ICH presentations.
  • 74.1% of patients (678/891) received anticoagulation reversal.
  • Reversal associated with significantly lower 24-hour mortality (aOR 0.32, 95% CI 0.18-0.56) and 90-day mortality (aOR 0.59, 95% CI 0.35-0.99).
  • Determinants of reversal included GCS, ICH volume, and time since last DOAC dose.

Study Design

Type

Observational (n=891)

Multicenter

Yes

Structured PICO

Does anticoagulation reversal reduce mortality in patients with oral anticoagulant-related intracerebral hemorrhage?

P
Population
891 patients with oral anticoagulant (OAC)–related intracerebral hemorrhage (ICH) admitted to 18 Spanish stroke centers, mean age 79.0±9.3 years, 60.7% male.
I
Intervention
Anticoagulation reversal
C
Comparator
No anticoagulation reversal
O
Outcome
Reversal administration (primary) and 24-hour and 90-day mortalityhard clinical

Main Result

Effect estimate: aOR 0.32 (95% CI 0.18-0.56)

Anticoagulation reversal in OAC-related ICH is associated with significantly reduced 24-hour and 90-day mortality, including in severe cases.

Cite This Study

Rodriguez-Luna et al. (2026) conducted an observational in Oral anticoagulant-related intracerebral hemorrhage (n=891). Anticoagulation reversal vs. No reversal was evaluated on 24-hour mortality (aOR 0.32, 95% CI 0.18-0.56). Anticoagulation reversal in OAC-related intracerebral hemorrhage was independently associated with lower 24-hour (aOR 0.32; 95% CI 0.18-0.56) and 90-day mortality (aOR 0.59; 95% CI 0.35-0.99).

synapsesocial.com/papers/69fd7fcdbfa21ec5bbf0862fhttps://doi.org/10.1093/esj/aakag023.327
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Reversal Treatment in Oral Anticoagulant-Related Intracerebral Hemorrhage—An Observational Study Based on the Swedish Stroke Register2020 · 11 citations
  2. 2Patient factors associated with receiving reversal therapy in oral anticoagulant‐related intracerebral hemorrhage2022 · 2 citations
  3. 3Evaluation of Direct Oral Anticoagulant Reversal Agents in Intracranial Hemorrhage2022 · 87 citations
  4. 4Reversal treatment and clinical outcomes in acute intracranial haemorrhage associated with oral anticoagulant use: protocol of a planned systematic review and meta-analysis2025 · 1 citations
  5. 5Abstract DP165: Anticoagulant Reversal in Intracerebral Hemorrhage: Insights from a National Survey2026