Abstract
Whether to resume antithrombotic treatment after oral anticoagulant–related intracerebral
haemorrhage (OAC-ICH) is debatable. In this study, we aimed at investigating long-term
outcome associated with OAC resumption after warfarin-related ICH, in comparison with
secondary prevention strategies with platelet inhibitors or antithrombotic discontinuation.
Participants were patients who sustained an incident ICH during warfarin treatment
(2002–2014) included in the Multicenter Study on Cerebral Hemorrhage in Italy. Primary
end-point was a composite of ischemic stroke/systemic embolism (SE) and all-cause
mortality. Secondary end-points were ischemic stroke/SE, all-cause mortality and major
recurrent bleeding. We computed individual propensity score (PS) as the probability
that a patient resumes OACs or other agents given his pre-treatment variables, and
performed Cox multivariable analysis using Inverse Probability of Treatment Weighting
(IPTW) procedure. A total of 244 patients qualified for the analysis. Unlike antiplatelet
agents, OAC resumption was associated with a lower rate of the primary end-point (weighted
hazard ratio [HR], 0.21; 95% confidence interval [CI], 0.09–0.45), as well as of overall
mortality (weighted HR, 0.17; 95% CI, 0.06–0.45) and ischemic stroke/SE (weighted
HR, 0.19; 95% CI, 0.06–0.60) with no significant increase of major bleeding in comparison
with patients receiving no antithrombotics. In the subgroup of patients with atrial
fibrillation, OACs resumption was also associated with a reduction of the primary
end-point (weighted HR, 0.22; 95% CI, 0.09–0.54), and the secondary end-point ischemic
stroke/SE (weighted HR, 0.09; 95% CI, 0.02–0.40). In conclusion, in patients who have
an ICH while receiving warfarin, resuming anticoagulation results in a favorable trade-off
between bleeding susceptibility and thromboembolic risk.
Keywords
stroke - haemorrhage - anticoagulants
