Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Incidence of Spontaneous Intracerebral Haemorrhage in Patients Prescribed Oral Anticoagulants: A Five-Year, Single-Centre Retrospective Study (#203)

Shirahn Ballah 1 , Hitarth Dalal 1 , Hadley Bortz 2 , Huyen Tran 3 4 , Geoffrey Cloud 5 6
  1. School of Medicine, Monash University, Melbourne, Victoria, Australia
  2. Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
  3. Department of Haematology, Alfred Health, Melbourne, Victoria, Australia
  4. Central Clinical School, Monash University, Melbourne, Victoria, Australia
  5. Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
  6. Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia

Background: Oral anticoagulants (OACs) are used commonly in patients with prosthetic heart valves, treatment of venous thromboembolism and systemic embolism prevention in atrial fibrillation. Intracranial haemorrhage is a feared and potentially fatal complication of OAC therapy. National stroke guidelines recommend reversal of OAC in selected patients with spontaneous intracerebral haemorrhage (sICH).

Aims: To investigate the incidence and type of OAC-associated sICH at a major tertiary neuroscience referral centre over a five-year period.

Methods: International Classification of Diseases (ICD-10) I60.x and I61.x discharge coding data were used to identify total events of intracranial haemorrhage (ICH), presenting from 1 January 2018 to 20 September 2022. Patients were included if they were on an OAC pre-admission and had sICH confirmed on imaging. Patients were excluded if the bleed was trauma-related, neoplastic, an incidental finding or a haemorrhagic transformation of a cerebral infarct. Primary outcome was the incidence of each OAC in OAC-associated sICH. Secondary outcomes were types of bleeds.

Results: There were 1781 ICH admission events screened, of which 72 (4%) patients met the criteria for inclusion (mean 15.2 per year). Among these, 39/72 (54%) were primary emergency department presentations and 33/72 (46%) interhospital transfers. Patients were most frequently taking apixaban 30/72 (41%), followed by warfarin 23/72 (32%), rivaroxaban 17/72 (24%) and dabigatran 2/72 (3%). There were intracerebral 64/72 (89%) and subarachnoid 8/72 (11%) haemorrhages. The bleed locations were cortical 37/72 (51%), subcortical 21/72 (29%), cerebellar 9/72 (13%) and intraventricular 5/72 (7%). Intraventricular extension was seen in 30/72 (42%).

Conclusion: OAC-associated sICH is uncommon in our comprehensive stroke service, accounting for 4% of all ICH admissions. About two-thirds were related to factor Xa inhibitors. Effective reversal of factor Xa inhibition is a potential therapeutic target in selected OAC-associated sICH.