How Do NOACs and Warfarin Affect Brain Bleed Outcomes?

Prior use of non-vitamin K oral anticoagulants (NOACs) is associated with a lower risk of in-hospital mortality compared with prior use of warfarin in patients with intracerebral hemorrhage (ICH), according to a new study.

Findings from the study were presented at the International Stroke Conference, which is taking place from January 24 to 26, 2018, in Los Angeles, California.
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For their study, the researchers assessed 141,311 patients with ICH who were admitted to 1662 hospitals between October 2013 and December 2016. Mean patient age was 68.3 years.

The researchers defined anticoagulant therapy before ICH as any use of oral anticoagulants (OACs) within 7 days before hospital admission.

Prior to hospital admission for ICH, 15,036 (10.6%) patients had been taking warfarin, 4918 (3.5%) had been taking NOACs, 39,585 (28.0%) had been taking concomitant single antiplatelet agents, and 5783 (4.1%) had been taking concomitant dual antiplatelet agents.

Unadjusted in-hospital mortality rates were 32.6% in warfarin patients, 26.5% in NOAC patients, and 22.5% in non-OAC patients. Ultimately, findings indicated that patients who had been taking warfarin had a higher risk of in-hospital mortality compared with those with no prior use of OACs (adjusted risk difference [ARD] 9.0%; adjusted odds ratio [AOR] 1.62).

The researchers also observed a numerically greater difference in mortality between patients taking NOACs vs warfarin among those with prior use of dual antiplatelet agents (32.7% vs 47.1%; ARD, −15.0%; AOR, 0.50) vs those who had taken these agents without prior antiplatelet therapy (26.4% vs 31.7%; ARD, −5.0%; AOR, 0.77).

“Among patients with ICH, prior use of NOACs or warfarin was associated with higher in-hospital mortality compared with no OACs,” the researchers concluded. “Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital mortality.”

—Christina Vogt

Reference:

Inohara T, Xian Y, Liang L, et al. Association of intracerebral hemorrhage among patients taking non-vitamin K antagonist vs vitamin K antagonist oral anticoagulants with in-hospital mortality [Published online January 25, 2018]. JAMA. doi:10.1001/jama.2017.21917.