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July 29, 2020Frontiers in NeurologyOpen Access

Withholding reversal treatment was associated with an increased 90-day death rate (HR = 1.47; 95% CI: 1.08-2.01, p=0.02) in a Cox regression model stratified for level of consciousness and adjusted for baseline imbalances.

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Why the study?

Intracerebral hemorrhage is the most serious adverse effect of oral anticoagulant treatment, but the effect of reversal therapy on outcome is uncertain.

Does OAC reversal therapy improve 90-day survival and functional outcome in patients with oral anticoagulant-related intracerebral hemorrhage?

Population

572 patients with oral anticoagulant-related intracerebral hemorrhage registered in Riksstroke during 2017

Comparison

Oral anticoagulant reversal therapy (n=369) vs non-reversal treatment (n=203)

Design

Observational registry-based study

Follow-up

90 days

Authors

TATrine Apostolaki‐HanssonTUTeresa UllbergMPMats Pihlsgård

Discussion

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Overview

Reversal was associated with better 90-day survival in OAC-ICH; leaves open whether randomized data will confirm benefit or change practice.

Structured PICO

Does OAC reversal therapy improve 90-day survival and functional outcome in patients with oral anticoagulant-related intracerebral hemorrhage?

P
Population
572 adults (>18 years) with intracerebral hemorrhage (ICH) during ongoing oral anticoagulant (OAC) treatment (VKA, apixaban, dabigatran, or rivaroxaban) registered in The Swedish Stroke Register (Riksstroke) during 2017.
I
Intervention
OAC reversal therapy (n=369), including prothrombin complex concentrate (PCC) and Vitamin K, PCC alone, or idarucizumab.
C
Comparator
No OAC reversal therapy (n=203).
O
Outcome
Mortality and functional outcome (modified Rankin Scale score) at 90 days post-OAC-ICH.hard clinical

OAC reversal therapy is associated with improved 90-day survival in patients with oral anticoagulant-related intracerebral hemorrhage, though a significant proportion of patients do not receive this treatment.

Limitations

  • Observational and retrospective design
  • Imbalances in baseline data suggesting confounding by indication
  • Lack of radiologic data regarding hemorrhage volumes and hematoma expansion
  • Data on clinical treatment decisions like withdrawal of care were not available
  • Data on the dosage and timing of administration of the hemostatic agent were not available
  • Data on acute blood pressure lowering were not available
  • 90-day functional outcome data are self-reported and 14% were lost to follow-up

Cite This Study

Apostolaki‐Hansson et al. (2020) studied this question.

synapsesocial.com/papers/6a709d242163a0a01bc4d2edhttps://doi.org/10.3389/fneur.2020.00760
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