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Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy.

Publication ,  Journal Article
Lopes, RD; Guimarães, PO; Kolls, BJ; Wojdyla, DM; Bushnell, CD; Hanna, M; Easton, JD; Thomas, L; Wallentin, L; Al-Khatib, SM; Held, C ...
Published in: Blood
June 1, 2017

We investigated the frequency and characteristics of intracranial hemorrhage (ICH), the factors associated with the risk of ICH, and outcomes post-ICH overall and by randomized treatment. We identified patients with ICH from the overall trial population enrolled in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial who received ≥1 dose of the study drug (n = 18 140). ICH was adjudicated by a central committee. Cox regression models were used to identify factors associated with ICH. ICH occurred in 174 patients; most ICH events were spontaneous (71.7%) versus traumatic (28.3%). Apixaban resulted in significantly less ICH (0.33% per year), regardless of type and location, than warfarin (0.80% per year). Independent factors associated with increased risk of ICH were enrollment in Asia or Latin America, older age, prior stroke/transient ischemic attack, and aspirin use at baseline. Among warfarin-treated patients, the median (25th, 75th percentiles) time from most recent international normalized ratio (INR) to ICH was 13 days (6, 21 days). Median INR prior to ICH was 2.6 (2.1, 3.0); 78.5% of patients had a pre-ICH INR <3.0. After ICH, the modified Rankin scale score at discharge was ≥4 in 55.7% of patients, and the overall mortality rate at 30 days was 43.3% with no difference between apixaban- and warfarin-treated patients. ICH occurred at a rate of 0.80% per year with warfarin regardless of INR control and at a rate of 0.33% per year with apixaban and was associated with high short-term morbidity and mortality. This highlights the clinical relevance of reducing ICH by using apixaban rather than warfarin and avoiding concomitant aspirin, especially in patients of older age. This trial was registered at www.clinicaltrials.gov as #NCT00412984.

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Published In

Blood

DOI

EISSN

1528-0020

Publication Date

June 1, 2017

Volume

129

Issue

22

Start / End Page

2980 / 2987

Location

United States

Related Subject Headings

  • Warfarin
  • Pyridones
  • Pyrazoles
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Intracranial Hemorrhages
  • International Normalized Ratio
  • Immunology
  • Humans
 

Citation

APA
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Lopes, R. D., Guimarães, P. O., Kolls, B. J., Wojdyla, D. M., Bushnell, C. D., Hanna, M., … Diener, H.-C. (2017). Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy. Blood, 129(22), 2980–2987. https://doi.org/10.1182/blood-2016-08-731638
Lopes, Renato D., Patrícia O. Guimarães, Bradley J. Kolls, Daniel M. Wojdyla, Cheryl D. Bushnell, Michael Hanna, J Donald Easton, et al. “Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy.Blood 129, no. 22 (June 1, 2017): 2980–87. https://doi.org/10.1182/blood-2016-08-731638.
Lopes RD, Guimarães PO, Kolls BJ, Wojdyla DM, Bushnell CD, Hanna M, et al. Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy. Blood. 2017 Jun 1;129(22):2980–7.
Lopes, Renato D., et al. “Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy.Blood, vol. 129, no. 22, June 2017, pp. 2980–87. Pubmed, doi:10.1182/blood-2016-08-731638.
Lopes RD, Guimarães PO, Kolls BJ, Wojdyla DM, Bushnell CD, Hanna M, Easton JD, Thomas L, Wallentin L, Al-Khatib SM, Held C, Gabriel Melo de Barros E Silva P, Alexander JH, Granger CB, Diener H-C. Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy. Blood. 2017 Jun 1;129(22):2980–2987.

Published In

Blood

DOI

EISSN

1528-0020

Publication Date

June 1, 2017

Volume

129

Issue

22

Start / End Page

2980 / 2987

Location

United States

Related Subject Headings

  • Warfarin
  • Pyridones
  • Pyrazoles
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Intracranial Hemorrhages
  • International Normalized Ratio
  • Immunology
  • Humans