Fernando D. Testai, Jordan Elm, Jonathan Rosand, Steven M. Greenberg, Christina Kourkoulis, Joji B. Kuramatsu, Hooman Kamel, Kristin Schwab, Anand Viswanathan, Kevin N Sheth, Stefan Schwab, Christopher D. Anderson, Alison M. Ayres, Audrey Leasure, Alessandro Biffi, Hagen B. Huttner, Daniel Woo, M. Edip Gurol
Objective: Oral Anticoagulation Treatment (OAT) resumption is a therapeutic dilemma in Intracerebral Hemorrhage (ICH) care, particularly for lobar hemorrhages related to amyloid angiopathy. We sought to determine whether OAT resumption after ICH is associated with long-term outcome, accounting for ICH location (i.e. lobar vs. non-lobar).
Methods: We meta-analyzed individual patient data from: 1) the multi-center RETRACE study (n=542); 2) a US-based single-center ICH study (n=261); 3) the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study (n=209). We determined whether, within one year from ICH, OAT resumption was associated with: 1) mortality; 2) favorable functional outcome (modified Rankin Scale [mRS] 0-3); stroke incidence. We separately analyzed non-lobar and lobar ICH cases using propensity score matching and Cox regression models.
Results: We included 1012 OAT-related ICH survivors (633 non-lobar and 379 lobar). Among non-lobar ICH survivors 178/633 (28%) resumed OAT, while 86/379 (23%) lobar ICH survivors did. In multivariable analyses OAT resumption after non-lobar ICH was associated with decreased mortality (Hazard Ratio [HR]=0.25, 95% Confidence Interval [CI]=0.14-0.44, p<0.0001) and improved functional outcome (HR=4.22, 95% CI=2.57-6.94, p<0.0001). OAT resumption after lobar ICH was also associated with decreased mortality (HR=0.29, 95% CI=0.17-0.45, p<0.0001) and favorable functional outcome (HR=4.08, 95% CI=2.48-6.72, p<0.0001). Furthermore, OAT resumption was associated with decreased all-cause stroke incidence in both lobar and non-lobar ICH (both p<0.01).
Interpretation: These results suggest novel evidence of an association between OAT resumption and outcome following ICH, regardless of hematoma location. These findings support conducting randomized trials to explore risks and benefits of OAT resumption after ICH. This article is protected by copyright. All rights reserved.