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

Characteristics of Patients Presenting with Oral Anticoagulant-Associated Spontaneous Intracerebral Haemorrhage: A Five-Year, Single-Centre Retrospective Study   (#204)

Hitarth Dalal 1 , Shirahn Ballah 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 routinely prescribed for conditions such as atrial fibrillation (AF), prosthetic heart valve replacements (VR) and venous thromboembolism (VTE). Bleeding remains an inherent risk, with spontaneous intracerebral haemorrhage (sICH) a potentially fatal consequence.

Aims: To characterise patients presenting with OAC-associated sICH over a five-year period at a tertiary neuroscience referral centre.

Methods: Through International Classification of Diseases (ICD-10) I60.x and I61.x discharge coding data, patient events of intracranial haemorrhage (ICH) were acquired from a major hospital centre from 1 January 2018 to 20 September 2022. Inclusion criteria was confirmed OAC-use pre-admission and sICH confirmed on imaging. Exclusion criteria were bleeds related to trauma, neoplasia, incidental findings, or haemorrhagic transformations of cerebral infarcts. Baseline demographics, medical comorbidities, pre-morbid modified Rankin scale (mRS), time of hospital arrival, first brain imaging, haematoma volume and expansion, and discharge outcomes were obtained. 

Results: Of 1781 ICH presentations, 72 were included (median age 79; female 36/72, 50%). OAC indications were primarily AF 52/72 (72%) and VR 12/72 (17%). Interhospital transfers (IHT) accounted for 33/72 (46%). Majority were known hypertensives 55/72 (76%). Median mRS was 1. Median ictus-to-arrival hours for primary emergency department presentations (PEDP) was 4.1, and 11.3 for IHT. Median door-to-imaging time for PEDP was 27.5 minutes. 20/72 (28%) died in hospital with a median length of stay (days) of 1.1 compared to 9.2 for survivors. Among available initial scans 33/72 (46%), fatal sICHs had a median initial sICH volume of 27 cm3 versus 7 cm3 for survivors. Majority of survivors 42/52 (81%) were discharged to a rehabilitation facility.

Conclusion:  OAC-associated sICH occurred in hypertensive, elderly, fit individuals that had a high early fatality (28% in 24 hours). Timely diagnosis and effective reversal remain an important therapeutic target.