Association of Intracerebral Hemorrhage Among Patients Taking Non-Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality.
Abstract
Although non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used
to prevent thromboembolic disease, there are limited data on NOAC-related intracerebral
hemorrhage (ICH).To assess the association between preceding oral anticoagulant use
(warfarin, NOACs, and no oral anticoagulants [OACs]) and in-hospital mortality among
patients with ICH.Retrospective cohort study of 141 311 patients with ICH admitted
from October 2013 to December 2016 to 1662 Get With The Guidelines-Stroke hospitals.Anticoagulation
therapy before ICH, defined as any use of OACs within 7 days prior to hospital arrival.In-hospital
mortality.Among 141 311 patients with ICH (mean [SD] age, 68.3 [15.3] years; 48.1%
women), 15 036 (10.6%) were taking warfarin and 4918 (3.5%) were taking NOACs preceding
ICH, and 39 585 (28.0%) and 5783 (4.1%) were taking concomitant single and dual antiplatelet
agents, respectively. Patients with prior use of warfarin or NOACs were older and
had higher prevalence of atrial fibrillation and prior stroke. Acute ICH stroke severity
(measured by the National Institutes of Health Stroke Scale) was not significantly
different across the 3 groups (median, 9 [interquartile range, 2-21] for warfarin,
8 [2-20] for NOACs, and 8 [2-19] for no OACs). The unadjusted in-hospital mortality
rates were 32.6% for warfarin, 26.5% for NOACs, and 22.5% for no OACs. Compared with
patients without prior use of OACs, the risk of in-hospital mortality was higher among
patients with prior use of warfarin (adjusted risk difference [ARD], 9.0% [97.5% CI,
7.9% to 10.1%]; adjusted odds ratio [AOR], 1.62 [97.5% CI, 1.53 to 1.71]) and higher
among patients with prior use of NOACs (ARD, 3.3% [97.5% CI, 1.7% to 4.8%]; AOR, 1.21
[97.5% CI, 1.11-1.32]). Compared with patients with prior use of warfarin, patients
with prior use of NOACs had a lower risk of in-hospital mortality (ARD, -5.7% [97.5%
CI, -7.3% to -4.2%]; AOR, 0.75 [97.5% CI, 0.69 to 0.81]). The difference in mortality
between NOAC-treated patients and warfarin-treated patients was numerically greater
among patients with prior use of dual antiplatelet agents (32.7% vs 47.1%; ARD, -15.0%
[95.5% CI, -26.3% to -3.8%]; AOR, 0.50 [97.5% CI, 0.29 to 0.86]) than among those
taking these agents without prior antiplatelet therapy (26.4% vs 31.7%; ARD, -5.0%
[97.5% CI, -6.8% to -3.2%]; AOR, 0.77 [97.5% CI, 0.70 to 0.85]), although the interaction
P value (.07) was not statistically significant.Among patients with ICH, prior use
of NOACs or warfarin was associated with higher in-hospital mortality compared with
no OACs. Prior use of NOACs, compared with prior use of warfarin, was associated with
lower risk of in-hospital mortality.
Type
Journal articleSubject
HumansCerebral Hemorrhage
Vitamin K
Warfarin
Anticoagulants
Platelet Aggregation Inhibitors
Administration, Oral
Registries
Hospital Mortality
Risk
Retrospective Studies
Confounding Factors (Epidemiology)
Aged
Aged, 80 and over
Female
Male
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https://hdl.handle.net/10161/21908Published Version (Please cite this version)
10.1001/jama.2017.21917Publication Info
Inohara, Taku; Xian, Ying; Liang, Li; Matsouaka, Roland A; Saver, Jeffrey L; Smith,
Eric E; ... Fonarow, Gregg C (2018). Association of Intracerebral Hemorrhage Among Patients Taking Non-Vitamin K Antagonist
vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality. JAMA, 319(5). pp. 463-473. 10.1001/jama.2017.21917. Retrieved from https://hdl.handle.net/10161/21908.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Adrian Felipe Hernandez
Duke Health Cardiology Professor
Roland Albert Matsouaka
Associate Professor of Biostatistics & Bioinformatics
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Ying Xian
Adjunct Associate Professor in the Department of Neurology
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