Abstract
Background Direct-oral-anticoagulant (DOAC) and warfarin treatment are associated with increased risk of intracerebral hemorrhage (ICH). Specific reversal agents exist for warfarin and dabigatran, however the data on 3-factor Prothrombin Complex Concentrate (PCC) included in protocols for the use in Factor Xa inhibitors is lacking.
Aims Our retrospective cohort study aimed to compare rates of non-dabigatran DOAC-related reversal with dabigatran/warfarin-related reversal following ICH. Timeliness of administration of reversal agents and intravenous anti-hypertensives and their impact on mortality and functional outcomes was assessed.
Methods Patients with non-traumatic ICH within 24 hours of presentation from the inception of electronical records until December 2022 in South Australian Tertiary Hospitals were included. Those with isolated intraventricular hemorrhage/secondary causes of ICH were excluded. Outcomes analyzed included 30-day mortality and discharge modified-Rankin-Scale (mRS). Secondary outcomes included time to administration of reversal agent, intravenous anti-hypertensives, and time to systolic blood pressure (BP) lowering <140 mmHg.
Results We included 102 patients (mean age 82(SD 9)) of whom 74 (73%) were in the non-dabigatran DOAC group and 28 (27%) in the warfarin/dabigatran group. No difference was observed between the two groups for reversal agent rates (46% dabigatran/warfarin vs non-dabigatran-DOAC 39% (OR, 1.4; 95% CI, 0.93–2.08), time to reversal (91.7 minutes (SD 137) dabigatran/warfarin vs non-dabigatran-DOAC 141 (SD 229); p=0.3), time to first dose of intravenous anti-hypertensives, time to BP <140, and 30-day mortality.
Conclusion In anticoagulated ICH patients, time to anticoagulation reversal and initiation of first IV anti-hypertensive was greater than 120 minutes irrespective of the pre-ICH anticoagulant.
