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Antithrombotic Treatment and Clinical Outcomes After Intracerebral Hemorrhage: A Retrospective Cohort Study from the Swedish Stroke Register
Örebro University, School of Medical Sciences. Department of Neurology and Rehabilitation, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0009-0009-2392-5341
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Clinical Epidemiology and Biostatistics.ORCID iD: 0000-0001-9204-1165
Örebro University, School of Medical Sciences. Department of Neurosurgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-2190-9278
Örebro University, School of Medical Sciences. Department of Neurology and Rehabilitation, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-3845-8100
2024 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 13, no 10, article id e034716Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A rapid shift has occurred from vitamin K antagonists toward direct oral anticoagulants, which have a lower risk of intracerebral hemorrhage (ICH). However, effects on clinical outcomes after ICH are understudied. We aimed to describe the prevalence of antithrombotic drugs and to study the prognosis among prestroke functionally independent Swedish patients with ICH.

METHODS AND RESULTS: We identified all patients diagnosed with nontraumatic ICH in 2017 to 2021 from the Swedish Stroke Register (n=13 155) and assessed death and functional outcome at 3 months after ICH in prestroke functionally independent patients (n=10 014). Functional outcome was estimated among 3-month survivors on the basis of self-reported activities of daily living scores. Risks of outcomes were estimated using Poisson regression. In 13 155 patients, 14.5% used direct oral anticoagulant, 10.1% vitamin K antagonists, and 21.6% antiplatelets at ICH onset. Among 10 014 pre-stroke activities of daily living-independent patients, oral anticoagulants and antiplatelets were associated with increased mortality risk (adjusted risk ratio, 1.27 [95% CI, 1.13-1.43]; P<0.001; and adjusted risk ratio, 1.23 [95% CI, 1.13-1.34]; P<0.001 respectively). Mortality risk did not statistically differ between antiplatelets and oral anticoagulants nor between direct oral anticoagulant and vitamin K antagonists. Among 5126 patients with nonmissing functional outcome (69.1% of survivors), antiplatelets (adjusted risk ratio, 1.06 [95% CI, 0.99-1.13]; P=0.100) and oral anticoagulants (adjusted risk ratio, 1.01 [95% CI, 0.92-1.12]; P=0.768) were not statistically significantly associated with functional dependence.

CONCLUSIONS: There was no statistically significant difference in mortality risk between direct oral anticoagulant and vitamin K antagonists in prestroke functionally independent patients (unadjusted for oral anticoagulant class indication). Furthermore, mortality risk in antiplatelet and oral anticoagulant users might differ less than previously suggested.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024. Vol. 13, no 10, article id e034716
Keywords [en]
Antithrombotic drugs, death, functional outcome, intracerebral hemorrhage, oral anticoagulants
National Category
Neurology
Identifiers
URN: urn:nbn:se:oru:diva-113689DOI: 10.1161/JAHA.123.034716ISI: 001228221200017PubMedID: 38726922Scopus ID: 2-s2.0-85194013585OAI: oai:DiVA.org:oru-113689DiVA, id: diva2:1859970
Funder
The Swedish Stroke Association
Note

The study was funded by the Swedish Stroke Foundation and by grants provided by the “Avtal om Läkarutbildning och Forskning agreement,” an agreement between the Swedish government and the Region Örebro Council. 

Available from: 2024-05-23 Created: 2024-05-23 Last updated: 2024-07-04Bibliographically approved

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Tallroth, MattiasUdumyan, RuzanBüki, Andrasvon Euler, Mia

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