Key result
Between 2010 and 2017, the proportion of intracerebral hemorrhage events related to oral anticoagulants increased from 13% to 22% (p<0.001), driven by an increase in NOAC-related ICH.
Why the study?
NOACs have become the first-choice oral anticoagulant over VKAs partly due to lower ICH risk, but trends relating OAC sales to OAC-related ICH needed evaluation.
Observational (n=2,877)
Answers are grounded in this paper and cite their sources.
The increasing use of NOACs in Denmark from 2010 to 2017 was associated with a rising proportion of OAC-related intracerebral hemorrhages among all ICH events.
INTRODUCTION: Non-vitamin K-antagonist oral anticoagulants (NOAC) have become first choice oral anticoagulant (OAC) with decreasing use of vitamin K antagonists (VKA), partly due to lower risk of intracerebral hemorrhage (ICH). Aim: to identify trends in sale of OACs and relate them to trends in OAC-related ICH (OAC-ICH). PATIENTS AND METHODS: Study was based on the population in the Capital Region of Denmark (1.8 million inhabitants). We identified all patients admitted with a non-traumatic OAC-ICH in 2010-2017 and ascertained diagnosis and drug use through medical charts. We used information available in the public domain on sale of defined daily doses (DDD) of OAC in the Capital Region of Denmark. RESULTS: 453 patients with OAC-ICH out of a total of 2877 ICH-events were identified. From 2010 to 2017 sale of NOAC rose from 0.1 to 11.8 DDD/1000 inhabitants/day (p < 0.001); while VKA sale decreased from 7.6 to 5.2 DDD/1000 inhabitants/day (p < 0.001). The total number of ICH events was stable between 2010 and 2017, but the proportion of OAC-ICH events increased from 13% in 2010 to 22% in 2017 (p < 0.001). The proportion of ICH events related to NOAC had a significant increasing trend (p < 0.001), whereas a decreasing trend was observed for VKA (p = 0.04). DISCUSSION: In Denmark, the population on OACs has increased; resulting from increased use of NOACs. Parallel to this development, the proportion of OAC-ICH overall has increased based on an increasing trend in NOAC-related ICH. CONCLUSION: Our findings document a need for further research on prevention and treatment of this complication.
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Grundtvig et al. (2021) conducted an observational in Intracerebral hemorrhage (n=2,877). Oral anticoagulants (NOACs and VKAs) was evaluated on Proportion of OAC-ICH events (p=<0.001). Between 2010 and 2017, the proportion of intracerebral hemorrhage events related to oral anticoagulants increased from 13% to 22% (p<0.001), driven by an increase in NOAC-related ICH.
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