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Anticoagulation after intracerebral hemorrhage in patients with atrial fibrillation: between Scylla and Charybdis

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Abstract

Background

Oral anticoagulants (OAC) are indicated in patients with atrial fibrillation (AF) and high risk of ischemic stroke. However, the introduction of anticoagulation in patients with AF and previous intracerebral hemorrhage (ICH) is controversial. We aimed to better understand the efficacy and safety of OAC in this context and to assess the factors that may influence this decision.

Methods

In a single-center retrospective observational study, patients with AF and ICH who survived hospitalization at a level A Stroke Unit between 2009 and 2018 were included. Patients were followed for two years after discharge. Data were collected regarding the introduction or not of OAC and the occurrence of major thrombotic/hemorrhagic events and death.

Results

Ninety-five patients (75.2 ± 9.9 years) were included and 40 patients (42.1%) started OAC. Patients were more likely to initiate anticoagulation if they had: mechanical prosthetic valves, previous AF (p = 0.005) and previous OAC therapy (p < 0001); and less if they had previous hemorrhagic stroke (p < 0.005). During follow-up, 10.5% had at least one major hemorrhagic event (60% anticoagulated), 20% had at least one major thrombotic event (all non-anticoagulated) and 20% died. The only factor associated with the risk of bleeding was ICH score (OR:2.49 per 1-point increase; 95%CI:1.14–5.46). Patients who initiated anticoagulation had lower mortality than non-anticoagulated (OR:0.296; 95%CI:0.090–0-975). Previous ICH and higher CHA2DS2-VASc were associated with higher mortality.

Conclusion

In this retrospective series, anticoagulation reduced thrombotic events and overall mortality in patients admitted for ICH and AF, without a significant increase in bleeding risk.

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Data availability

Data were collected after authorization from the São João University Hospital Center. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Carla Seabra Abrantes, Mariana Pintalhão & Paulo Castro Chaves

  2. Cardiovascular Research Centre (UnIC), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Mariana Pintalhão & Paulo Castro Chaves

  3. Department of Internal Medicine, São João Hospital Centre, Alameda Prof. HernâniMonteiro, 4200-319, Porto, Portugal

    Mariana Pintalhão, Sofia Tavares, Luísa Fonseca & Paulo Castro Chaves

Authors
  1. Carla Seabra Abrantes
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  2. Mariana Pintalhão
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  3. Sofia Tavares
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  4. Luísa Fonseca
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  5. Paulo Castro Chaves
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Corresponding author

Correspondence to Carla Seabra Abrantes.

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Ethical approval

The protocol was previously approved by the Ethics Committee of our Institution. Due to the retrospective nature of the study, the Ethics Committee agreed that the submission of informed consent is waived. We have these documentation that can be send in attachment.

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The authors declare no competing interests.

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Abrantes, C.S., Pintalhão, M., Tavares, S. et al. Anticoagulation after intracerebral hemorrhage in patients with atrial fibrillation: between Scylla and Charybdis. Neurol Sci 43, 2441–2448 (2022). https://doi.org/10.1007/s10072-021-05602-7

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  • DOI: https://doi.org/10.1007/s10072-021-05602-7

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