JAMA Neurol

International Stroke Conference: Faster anticoagulation reversal linked to better ICH outcomes

February 16, 2024

Intracerebral hemorrhage (ICH) is the deadliest stroke subtype, and mortality rates are especially high in anticoagulation-associated ICH. Specific anticoagulation reversal strategies have been developed, but research is lacking as to whether there is a time-dependent treatment effect for door-to-treatment (DTT) times in clinical practice. In this cohort study of 9,942 patients, researchers found that earlier anticoagulation reversal was associated with improved survival for patients with ICH. These findings support intensive efforts to accelerate evaluation and treatment for patients with ICH.

• This study relied on data from the American Heart Association’s Get with the Guidelines-Stroke quality improvement registry. Patients with ICH who presented within 24 hours of symptom onset across 465 US hospitals from 2015 to 2021 were included.
• The primary outcome of interest was the composite of inpatient mortality and discharge to hospice.
• Of 9,492 patients with anticoagulation-associated ICH and documented reversal intervention status, 44.6% were female, and median age was 77 years.
• A total of 7,469 received reversal therapy, including 4,616 of 5,429 (85.0%) taking warfarin and 2,856 of 4,069 (70.2%) taking a non–vitamin K antagonist oral anticoagulant.
• For the 5,224 patients taking a reversal intervention with documented workflow times, the median onset-to-treatment time was 232 minutes and the median DTT time was 82 minutes, with a DTT time of 60 minutes or less in 27.7%.
• A DTT time of 60 minutes or less was associated with decreased mortality and discharge to hospice (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69-0.99) but no difference in functional outcome (aOR, 0.91; 95% CI, 0.67-1.24).
• Factors associated with a DTT time of 60 minutes or less included White race, higher systolic BP, and lower stroke severity.

Source:

Sheth KN, et al. (2024, February 9). JAMA Neurol. Time to Anticoagulation Reversal and Outcomes After Intracerebral Hemorrhage. https://pubmed.ncbi.nlm.nih.gov/38335064/