Intracerebral Hemorrhage: Restarting Oral Anticoagulation

Regardless of intracerebral hemorrhage location, restarting oral anticoagulation is associated with favorable outcomes.

Restarting oral anticoagulation after intracerebral hemorrhage (ICH) is associated with favorable outcomes, according to study results presented at the 2017 International Stroke Conference in Houston, Texas.

The researchers conducted a meta-analysis of 3 ICH studies: German-wide Multicenter Analysis of Oral Anticoagulation-Associated ICH (RETRACE), Massachusetts General Hospital study (MGH), and Ethnic/Racial Variations of ICH (ERICH) study. They were particularly concerned with the effect of ICH location on outcomes after resuming oral anticoagulation, as this had not been studied previously.


Nonlobar and lobar ICH cases were separately analyzed using multivariable (Cox regression) models, adjusting for ICH volume, discharge modified Rankin Scale (mRS), and CHADS2 and HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) scores.

A total of 641 cases of nonlobar and 386 cases of lobar ICH were included; 28% of patients with nonlobar ICH restarted oral anticoagulation therapy vs 23% of patients with lobar ICH. None of the adjustments detailed above were associated with restarting therapy in either lobar or nonlobar ICH (all P >.20). Only discharge mRS in lobar ICH was associated with resuming anticoagulation (P =.011).

In addition, the researchers found that restarting oral anticoagulation in nonlobar ICH was associated with decreased mortality in multivariable analyses (hazard ratio [HR], 0.22; 95% CI, 0.16-0.30; P <.0001) and improved functional outcome (HR, 5.12; 95% CI, 3.86-6.80; P <.0001) at 1 year. After lobar ICH, resuming anticoagulation was also associated with decreased mortality (HR, 0.25; 95% CI, 0.17-0.38; P <.0001) and favorable functional outcome (HR, 4.89; 95% CI, 3.25-7.36; P <.0001).

The researchers also pointed out the decreased risk of recurrent stroke at 1 year when restarting oral anticoagulation in both nonlobar (P =.22) and lobar ICH (P =.059).

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Biffi A, Kuramatsu J, Leasure A, et al. Resumption of oral anticoagulation after intracerebral hemorrhage is associated with decreased mortality and favorable functional outcome. LB6. Presented at: the 2017 International Stroke Conference. February 22-24, 2017; Houston, TX.