TY - JOUR
T1 - Anticoagulants Resumption after Warfarin-Related Intracerebral Haemorrhage
T2 - The Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy)
AU - Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy) Investigators
AU - Poli, Loris
AU - Grassi, Mario
AU - Zedde, Marialuisa
AU - Marcheselli, Simona
AU - Silvestrelli, Giorgio
AU - Sessa, Maria
AU - Zini, Andrea
AU - Paciaroni, Maurizio
AU - Azzini, Cristiano
AU - Gamba, Massimo
AU - Toriello, Antonella
AU - Tassi, Rossana
AU - Giorli, Elisa
AU - Calabrò, Rocco Salvatore
AU - Ritelli, Marco
AU - De Vito, Alessandro
AU - Pugliese, Nicola
AU - Martini, Giuseppe
AU - Lanari, Alessia
AU - Lodigiani, Corrado
AU - Padroni, Marina
AU - De Giuli, Valeria
AU - Caria, Filomena
AU - Morotti, Andrea
AU - Costa, Paolo
AU - Strambo, Davide
AU - Corato, Manuel
AU - Pascarella, Rosario
AU - Del Sette, Massimo
AU - Malferrari, Giovanni
AU - Colombi, Marina
AU - Padovani, Alessandro
AU - Pezzini, Alessandro
N1 - Schattauer GmbH Stuttgart.
PY - 2018/2/12
Y1 - 2018/2/12
N2 - 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.
AB - 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.
U2 - 10.1055/s-0038-1627454
DO - 10.1055/s-0038-1627454
M3 - Article
C2 - 29433151
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
SN - 0340-6245
ER -