Key result
Anticoagulant prescription in older adults aged 75 years or older was associated with a significantly higher incidence of hospitalization for hemorrhagic stroke compared to no prescription (HR 1.64).
Why the study?
Population-based studies evaluating the association between anticoagulant use and hemorrhagic stroke incidence in older adults are limited, including potential differences between warfarin and DOACs.
Does anticoagulant use increase the risk of hospitalization for hemorrhagic stroke in older adults aged ≥ 75 years?
Cohort (n=717,097)
Does anticoagulant use increase the risk of hospitalization for hemorrhagic stroke in older adults aged ≥ 75 years?
In adults aged 75 and older, anticoagulant use is associated with an increased risk of hemorrhagic stroke hospitalization, with warfarin posing a significantly higher risk than DOACs.
Answers are grounded in this paper and cite their sources.
Supports careful bleeding risk assessment before anticoagulants in adults ≥75; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Population-based studies on the association between anticoagulant use and the incidence of hemorrhagic stroke in older adults are limited. We examined the association between anticoagulant prescription and hospitalization for hemorrhagic stroke and whether this association varies between warfarin and direct oral anticoagulants (DOACs). METHODS: This propensity score-matched retrospective cohort study used medical insurance claim data from Hokkaido, Japan. Older adults aged ≥ 75 years receiving medical care between April 2016 and March 2017 (baseline period) were included. The exposure variable was prescription of anticoagulants during the baseline period and outcome variable was hospitalization for hemorrhagic stroke between April 2017 and March 2020. A one-to-one matched design adjusted for covariates (age, sex, copayment rate, comorbidities, annual health check-up, and care needs certification) compared the incidence of hospitalization between patients prescribed and those not prescribed anticoagulants. RESULTS: Among 717,097 patients, 66,916 (9.3%) were prescribed anticoagulants. After propensity score matching, the incidence of hospitalization for hemorrhagic stroke was higher in patients prescribed anticoagulants (383.2 per million person-month) than in those who were not prescribed anticoagulants (252.2 per million person-month) (hazard ratio [HR] = 1.64; 95% Confidence interval [CI], 1.39-1.93). Moreover, among patients prescribed one anticoagulant (n = 61,556), after matching, the incidence of hospitalization for hemorrhagic stroke was significantly higher in patients prescribed warfarin than in those prescribed DOACs (HR, 1.67; 95% CI, 1.39-2.01). CONCLUSIONS: The findings of this study highlight the need for careful consideration when prescribing anticoagulants, particularly warfarin, to older adults to minimize the risk of hemorrhagic stroke.
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Mitsutake et al. (2025) conducted a cohort in Older adults aged ≥75 years (n=717,097). Anticoagulants vs. No anticoagulants was evaluated on Hospitalization for hemorrhagic stroke (HR 1.64, 95% CI 1.39-1.93, p=<0.001). Anticoagulant prescription in older adults aged 75 years or older was associated with a significantly higher incidence of hospitalization for hemorrhagic stroke compared to no prescription (HR 1.64).
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