Why the study?
Intracranial hemorrhage carries severe prognosis and recurrence risk, impacting anticoagulation resumption decisions in patients with AF or VTE.
Does DOAC use reduce recurrent intracranial hemorrhage compared to VKA in patients with atrial fibrillation or venous thromboembolism resuming anticoagulation after a first ICH?
Does DOAC use reduce recurrent intracranial hemorrhage compared to VKA in patients with atrial fibrillation or venous thromboembolism resuming anticoagulation after a first ICH?
There is a non-significant trend toward fewer recurrent intracranial hemorrhages in patients resuming DOACs compared to VKAs after a first ICH.
Recurrent ICH rates appear lower with DOACs than VKAs after resumption; leaves open optimal timing, selection, and net benefit.
BACKGROUND: Intracranial hemorrhage (ICH) is associated with severe prognosis and recurrent risk. This impacts on the decision to resume anticoagulation in atrial fibrillation (AF) or venous thromboembolism (VTE) patients. Purpose of our study is to evaluate the incidence rate of recurrent ICH in patients with AF or VTE resuming anticoagulation after a first ICH episode. METHODS: We report data of two cohorts of AF or VTE after a first ICH. The Vitamin K antagonist (VKA) cohort (166 patients) derives from CHIRONE Study, the direct oral anticoagulant (DOAC) cohort (178 patients) derives from START2-Register RESULTS: The clinical characteristics of the two cohort are similar with the exception of more prevalence of history of previous stroke/TIA in DOAC patients with respect to VKA (p = 0.02) and serum creatinine levels>1.5 mg/dL in VKA patients with respect to DOAC(p = 0.0001). The index ICH was spontaneous in 66.4% and in 33.7% among DOAC and VKAs cohort respectively (p = 0.0001). During follow-up, 14 recurrent ICH were recorded; 9 (rate 2.5 × 100 patient-years) in VKA and 5 (rate 1.3 × 100 patient-years) in DOAC (Relative Risk 1.9; 95% CI 0.6-7.4; p = 0.2). The univariate logistic regression analysis showed that patients with recurrent ICH were more frequently males, hypertensive, with a history of previous Stroke/TIA and older than patients without recurrence. VKA patients showed a higher risk of recurrence with respect to DOAC patients (OR 1.9;95% CI 0.7-6.7). CONCLUSIONS: A trend toward fewer ICH recurrences was detected among DOACs patients in comparison to the previously reported rate of patients on warfarin.
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Poli et al. (2020) studied this question.
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