What does this research mean for the field?

The prevalence of atrial fibrillation and oral anticoagulant use among patients with intracerebral hemorrhage has increased over time, and premorbid oral anticoagulant use, rather than atrial fibrillation itself, is independently associated with increased mortality after intracerebral hemorrhage. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 1, 2021Journal of the American Heart AssociationOpen Access

Atrial Fibrillation in Spontaneous Intracerebral Hemorrhage, Dijon Stroke Registry (2006–2017)

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Why the study?

Atrial fibrillation is a major indication for oral anticoagulants that contribute to spontaneous intracerebral hemorrhage, prompting evaluation of AF prevalence, temporal trends, and early outcomes in patients with ICH.

Is atrial fibrillation or premorbid oral anticoagulant use associated with worse early functional outcomes and death in patients with spontaneous intracerebral hemorrhage?

Structured PICO

Is atrial fibrillation or premorbid oral anticoagulant use associated with worse early functional outcomes and death in patients with spontaneous intracerebral hemorrhage?

Population

444 patients with first-ever spontaneous intracerebral hemorrhage (ICH) from the population-based stroke registry of Dijon, France (2006-2017)

Intervention

Atrial fibrillation (AF) and premorbid oral anticoagulant (OAC) use

Comparator

No atrial fibrillation / no premorbid OAC use

Outcome

Early functional outcome (ordinal modified Rankin Scale score) and death at dischargehard clinical

In patients with spontaneous intracerebral hemorrhage, premorbid use of oral anticoagulants, rather than atrial fibrillation itself, is associated with a higher probability of death at discharge.

Implication

Premorbid OAC use may flag higher mortality risk in spontaneous ICH; leaves open AF's independent prognostic role after adjustment.

Abstract

Background Atrial fibrillation (AF) represents a major indication for oral anticoagulants (OAC) that contribute to spontaneous intracerebral hemorrhage (ICH). This study evaluated AF prevalence among patients with ICH, temporal trends, and early functional outcomes and death of patients. Methods and Results Patients with first‐ever ICH were prospectively recorded in the population‐based stroke registry of Dijon, France, (2006–2017). Association between AF and early outcome of patients with ICH (ordinal modified Rankin Scale score and death at discharge) were analyzed using ordinal and logistic regressions. Among 444 patients with ICH, 97 (21.9%) had AF, including 65 (14.6%) with previously known AF treated with OAC, and 13 (2.9%) with newly diagnosed AF. AF prevalence rose from 17.2% (2006–2011) to 25.8% (2012–2017) ( P ‐trend=0.05). An increase in the proportion of AF treated with OAC (11.3% to 17.5%, P ‐trend=0.09) and newly diagnosed AF (1.5% to 4.2%, P ‐trend=0.11) was observed. In multivariable analyses, after adjustment for premorbid OAC, AF was not significantly associated with ordinal modified Rankin Scale score (odds ratio [OR], 1.29; 95% CI, 0.69–2.42) or death (OR, 0.89; 95% CI, 0.40–1.96) in patients with ICH. Nevertheless, adjusted premorbid OAC use remained highly associated with a higher probability of death (OR, 2.53; 95% CI, 1.11–5.78). Conclusions AF prevalence and use of OAC among patients with ICH increased over time. Premorbid use of OAC was associated with poor outcome after ICH, thus suggesting a need to better identify ICH risk before initiating or pursuing OAC therapy in patients with AF, and to develop acute treatment and secondary prevention strategies after ICH in patients with AF.