The Effect of Use of Anticoagulation on In-hospital Mortality for Patients Presenting with Primary Intracerebral Hemorrhage

Friday, May 3, 2024

Presenting Author(s)

Racheed M. Mani, MD

Resident Physician
Department of Neurological Surgery, Stony Brook University Hospital
Lake Grove, NY, US

Submitter(s)

JB

Jade Basem, BA

Medical Student
Renaissance School of Medicine at Stony Brook University
Coram, NY, US

Co-Author(s)

RD

Reza Dashti, MD, PhD

Attending Physician
Department of Neurological Surgery, Stony Brook University Hospital
Stony Brook, New York, United States
FF

Farshid Faraji, MD

Resident Physician
Department of Radiology, Stony Brook University Hospital, United States
Kevin Gilotra, BS

Medical Student
Renaissance School of Medicine at Stony Brook University
Centereach, NY, US
MJ

Melissa Janssen, MD

Resident Physician in Neurological Surgery
Department of Neurological Surgery, Loma Linda Medical Center
Loma Linda, California, United States
Sujith Swarna, BS

Medical Student
Renaissance School of Medicine at Stony Brook University
Stony Brook, NY, US
XZ

Xiaoyue Zhang, MS

Data Scientist
Biostatistical Consulting Core, Renaissance School of Medicine at Stony Brook University, United States

Introduction: Primary intracerebral hemorrhage (ICH) carries a significant risk of morbidity and mortality. Various studies have analyzed baseline demographics and clinical outcomes for ICH patients on various AC regimens, with mixed results with respect to AC use and significant comorbidities and clinical outcomes. We seek to compare preexisting medical co-morbidities, and management outcomes including in hospital mortality between primary ICH patients with and without pre-admission AC use.

Methods: The Stony Brook ICH database is a retrospective cohort of 814 patients that presented with primary ICH from January 2011 to January 2021, from which we analyzed 781 adult (age range 18-102, mean age 73 +/- 19.5) patients with primary ICH for whom AC use status was documented. We compared patients on AC (n=188) at the time of their admission to those who were not on an AC regimen (n=593), on various medical co-morbidities and outcomes of in-hospital mortality and hematoma expansion during admission.

Results: There were 188 admitted patients on prior AC compared with 593 who were not on AC. There was a statistically significant association between AC use and advanced age, concomitant antiplatelet use, hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, deep vein thrombosis pulmonary embolus, renal insufficiency, congestive heart failure, and in-hospital mortality. There was no statistically significant difference in hematoma expansion between patients on prior AC and those not on prior AC.

Conclusion : AC use in our patient cohort had a wide range of medical and cardiovascular co-morbidities, and was associated with increased in-hospital mortality. However, AC did not confer an increased risk of hematoma expansion. This may be attributable to the efficient and timely use of AC reversal agents for various classes of AC. This provides further avenues of prospective investigation aiming analysis of outcomes based on reversal agent use, and comparative analyses within specific classes of AC.