The timing of the resumption of anticoagulants and its relationship to clinical outcomes in patients with intracerebral hemorrhage

Abstract

This study examined the timing of the resumption of anticoagulants and its relationship to clinical outcomes in patients with intracerebral hemorrhage. The subjects comprised of 380 patients with non-traumatic intracerebral hemorrhage treated at our hospital between January 2013 and December 2014. Of the 380 patients, 37 (9.7%) had been receiving anticoagulant treatment: warfarin in 32 and direct oral anticoagulant (DOAC) in 5. The median age was 72 years, the median bleeding volume was 9 ml, and median international normalized ratio on admission was 1.81. A total of 20 patients resumed anticoagulant treatment during hospitalization, of which over half of them (11 patients) were given a DOAC. The CHA₂DS₂-VASc score was used as the criterion for the resumption of anticoagulants, and the median value was 3.5. The median time to the resumption of anticoagulant treatment was 4 days. At the time of resumption, the median HAS-BLED score was 3 and median systolic blood pressure was 139 mmHg. Two patients had cerebrovascular events: one had a cerebral infarction 6 days after the withdrawal of anticoagulants and another had an intracerebral hemorrhage 18 months after the resumption of warfarin. No recurrent intracerebral hemorrhage was observed in patients who resumed DOAC. These results showed that patients who resumed anticoagulants after 4 days of withdrawal had a low risk of recurrent intracerebral hemorrhage. The low incidence of recurrent intracerebral hemorrhage was considered to be related to the risk management at the time of resumption and selection of DOAC for the majority of patients.