Spontaneous Intracranial Hemorrhage and Oral Anticoagulation: A Retrospective Study

Background: Canadian data on intracranial hemorrhage (ICH) associated with oral anticoagulation is limited. Objectives: Primary study outcomes were baseline hematoma volumes and in-hospital mortality in patients with ICH associated with direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs). Secondary outcomes included the use of four-factor prothrombin complex concentrate (4f-PCC). Methods: Retrospective cohort study of patients with ICH associated with oral anticoagulation in three tertiary care hospitals in Montreal, Canada, between 2011 and 2018. Results: Twenty-nine patients were receiving DOACs and 114 patients were under VKAs. Median baseline hematoma volumes were similar, 14.8 ml [5.7–42.8] in the DOAC group and 15.6 ml [5.9–38.1] in the VKA group (p = 0.91). In-hospital mortality rate was 34.5% in the DOAC group and 48.2% in the VKA group (p = 0.26). Only 17 patients (58.6%) in the DOAC group received 4f-PCC. Conclusion: Our study did not demonstrate significant differences in outcomes of ICH associated with DOACs versus VKAs. Management approaches were variable.