What is the clinical evidence from this study?

Study design: Cohort. Population: Intracranial haemorrhage (ICH) (n=171). Intervention: Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs). Primary outcome: In-hospital mortality (aOR 1.30, 95% CI 0.39-4.36, p=0.67).

What does this research mean for the field?

Patients with DOAC-associated intracranial hemorrhage have comparable in-hospital mortality and 90-day functional outcomes to those using vitamin K antagonists. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate the clinical outcomes of patients with intracranial haemorrhage using direct oral anticoagulants versus vitamin K antagonists.

April 22, 2026Open Access

Outcomes of Intracranial Haemorrhage in Patients Taking Direct Oral Anticoagulants or Vitamin K Antagonists: A Seven-Year Single-Centre Retrospective Analysis

Key Result

Patients with DOAC-associated intracranial hemorrhage had comparable in-hospital mortality (aOR 1.30; 95% CI 0.39-4.36; p=0.67) and 90-day functional outcomes compared to those using VKAs.

Key Points

This research aims to evaluate the clinical outcomes of patients with intracranial haemorrhage using direct oral anticoagulants versus vitamin K antagonists.
Conducted a seven-year retrospective analysis of hospitalized patients with ICH using OACs from 2017-2023.
Primary outcomes assessed included mortality and functional outcomes measured with the modified Rankin Scale during hospitalization and at 90 days follow-up.
Compared management strategies and complications between patients on DOACs and VKAs.
171 patients were included: 24 on DOACs and 147 on VKAs, with a significant age difference (79.1 vs. 66.8 years).
In-hospital mortality and functional outcomes at 90 days showed no significant difference between the two groups, with adjusted odds ratios indicating similar outcomes.
Use of reversal agents differed, with fresh frozen plasma more common in the VKA group and prothrombin complex concentrate more common in the DOAC group.

Study Design

Type

Cohort (n=171)

Multicenter

Structured PICO

Does DOAC use compared to VKA use improve mortality and functional outcomes in patients with intracranial haemorrhage?

Population

171 patients hospitalised for traumatic and non-traumatic intracranial haemorrhage (ICH) while using oral anticoagulants (OACs)

Intervention

Direct oral anticoagulants (DOACs) (n=24)

Comparator

Vitamin K antagonists (VKAs) (n=147)

Outcome

Mortality and functional outcomes, as measured by the modified Rankin Scale (mRS) during admission and 90-day follow-uphard clinical

In patients with oral anticoagulant-associated intracranial haemorrhage, clinical outcomes and mortality were comparable between those taking DOACs and those taking VKAs.

Main Result

Effect estimate: aOR 1.30 (95% CI 0.39-4.36)

p-value: p=0.67

Abstract

Background: The clinical outcomes of patients with intracranial haemorrhage (ICH) whilst using direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) are uncertain. This study aimed to assess outcomes and management in patients receiving DOACs compared with those receiving VKAs. Methods: In this retrospective study, patients hospitalised during the period from 1 January 2017 to 31 December 2023 for traumatic and non-traumatic ICH and using oral anticoagulants (OACs) were included. The primary outcomes were mortality and functional outcomes, as measured by the modified Rankin Scale (mRS) during admission and 90-day follow-up. ICH management and complications were studied and compared between the two OAC groups. Results: A total of 171 eligible patients were included, comprising 24 patients on DOACs and 147 patients on VKAs. Patients receiving DOACs were older (79.1 vs. 66.8, p < 0.001) and had a higher proportion of traumatic ICH (75.0% vs. 46.3%, p = 0.009) than those receiving VKAs. In-hospital and 90-day outcomes were not statistically different between the two groups, with an adjusted odds ratio (aOR) of 1.30 (0.39–4.36) for in-hospital mortality, p = 0.67, and an aOR of 0.89 (0.33–2.41) for mRS 0–2 at 90 days, p = 0.83. In total, 81.3% of patients received at least one reversal agent; fresh frozen plasma was commonly used in the VKA group (78.9% vs. 33.3%, p < 0.001), whereas prothrombin complex concentrate was significantly prescribed in patients with DOAC-associated ICH (29.2% vs. 3.4%, p < 0.001). Conclusions: Patients with DOAC-associated ICH had comparable in-hospital and long-term clinical outcomes to those with VKA use.

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