Safety of Anticoagulant Therapy Including Direct Oral Anticoagulants in Patients With Acute Spontaneous Intracerebral Hemorrhage.

Abstract

BACKGROUND:

Because the efficacy and safety of anticoagulant therapy in patients with acute intracerebral hemorrhage (ICH) are not fully known, present study aimed to elucidate the current status and the safety of anticoagulant therapy, mainly direct oral anticoagulants (DOACs), for acute ICH and anticoagulant-indicated patients. Methods and Results: From September 2014 through March 2017, consecutive patients with acute (<7 days from onset), spontaneous ICH were retrospectively enrolled from a prospective registry. Whether to start anticoagulation was at the attending physicians' discretion, and thromboembolic or hemorrhagic events during hospitalization were analyzed. A total of 236 patients (80 women [34%]; median age 69 [interquartile range 61-79] years; National Institutes of Health stroke scale score 7 [3-16]) were enrolled. Of them, 47 patients (20%) had an indication for anticoagulant therapy (33 had atrial fibrillation, 14 developed deep vein thrombosis), and 41 of 47 patients (87%) were actually treated with anticoagulant therapy (DOACs were used in 34 patients) after a median of 7 days from ICH onset. There was neither hematoma expansion nor excessive hemorrhagic complications during hospitalization after starting anticoagulant therapy.

CONCLUSIONS:

Anticoagulant therapy was conducted for approximately 90% of anticoagulation-indicated patients after a median of 7 days from ICH onset. The predominant anticoagulant medications were DOACs. Anticoagulant therapy started from the acute phase of ICH should be safe.

• Authors: Yuki Sakamoto, Chikako Nito, Yasuhiro Nishiyama, Satoshi Suda, Noriko Matsumoto, Junya Aoki, Takashi Shimoyama, Takuya Kanamaru, Kentaro Suzuki, Takuya Nishimura, Masahiro Mishina, Kazumi Kimura
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 83 Issue 2 Pg. 441-446 (01 25 2019) ISSN: 1347-4820 [Electronic] Japan
• PMID: 30587698 (Publication Type: Journal Article)

Chemical References

• Anticoagulants
• Factor Xa Inhibitors

Topics

• Acute Disease
• Aged
• Anticoagulants (adverse effects, therapeutic use)
• Cerebral Hemorrhage (drug therapy)
• Factor Xa Inhibitors (therapeutic use)
• Female
• Hemorrhage (chemically induced)
• Humans
• Male
• Middle Aged
• Registries
• Retrospective Studies
• Treatment Outcome