Prognosis of Intracerebral Hemorrhage Patients in Comparison Regarding Their Anticoagulation Status - A Single-Centered, Cross-Sectional, Retrospective Study


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ŞEVİK Ö. E., KÖKSAL M. E., ÇANAKÇI M. E., ACAR N.

European Society of Emergency Medicine 2022 Congress, Berlin, Almanya, 15 Ekim 2022, ss.495

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Basıldığı Şehir: Berlin
  • Basıldığı Ülke: Almanya
  • Sayfa Sayıları: ss.495
  • Eskişehir Osmangazi Üniversitesi Adresli: Evet

Özet

Introduction: Spontaneous intracerebral hemorrhages (ICH) are a major risk factor for mortality and morbidity, especially in the elderly population due to their increased need for anticoagulation for various diseases. Warfarin was the choice of agent for patients with atrial fibrillation and/or mechanical valve replacements but recent introduction of direct oral anticoagulants (DOAC) allowed clinicians to prescribe those drugs as well. Risk and prognosis of patients who are taking DOACs are relatively unknown thus far. We compared patients who received no-anticoagulation, warfarin, or DOAC before admission in terms of the hematoma volumes, mortalities, and morbidities of the ICH patients that have been admitted to our Emergency Department (E.D.) in one year.

 

Patients & Methods: This research is a single-centered, cross-sectional, retrospective study which is conducted in a third-level university hospital. Information about patients who were admitted to the E.D. between 21.04.2021 and 21.04.2022, and got diagnosed with ICH was collected from the hospital database. Patients who were younger than eighteen years old and had traumatic bleedings were excluded. Primary outcome was to determine hematoma volumes of the patients. Secondary outcome was to determine mortality and morbidity of the patients and factors that affect those rates.

 

Results: After exclusion 108 patients were included in the study and 49.1% (n=53) were women. Median age of the patients was 70.0 [IQR: 60.0-79.0]. Thirty-four patients (31.5%) died during their hospital stay, 12 patients (11.1%) were discharged without any sequela and rest had various neurological morbidities on their discharge. Eight patients were using DOACs (7.4%) and 7 patients were using Warfarin (6.5%) and none were using unfractionated heparin or low-molecular-weight heparin (Table-1). Hematoma volumes were higher in patients who died with a median volume of 13.45mL [IQR: 2.87-24.65] (p=0.008). Patients who had ICH which has extended into the ventricles ((n=19) 55.9%) were at higher risk of mortality (p<0.001) (Table-2). Comparing DOACs, Warfarin and no-anticoagulation group we have found that hematoma volumes did not differ significantly with 4.8mL [IQR: 1.42-16.67], 4.8mL [IQR: 0.4-11.8], 6.2mL [IQR: 2.15-16.5] for groups respectively (p=0.733). Mortalities of these groups were: n=4 (50%), n=2 (28.6%) and n=28 (30.1%) respectively (p=0.493).

 

Discussion: Higher hematoma volumes were found to be related to mortality which is in line with the current literature. While statistically insignificant, oral anticoagulation of any kind does not increase the hematoma volumes of ICH patients on admission. This might be due to the mechanism of the disease as hypertensive bleeds are the most common etiology. Use of anticoagulation (DOACs more than Warfarin) was associated with higher mortality in our study. This finding was not statistically significant but it might have clinical significance. Another point that should be mentioned was the median age of patients who were using DOACs were higher which might have contributed to the mortality rates. ICHs could be fatal with or without anticoagulation. While more studies are needed to determine the safest agent to use in patients who need anticoagulation, all patients should be evaluated carefully for their hematoma volumes as it can determine the prognosis of these patients.