Antithrombotic Treatment Following Intracerebral Hemorrhage in Patients With and Without Atrial Fibrillation

Johanna Pennlert; Kjell Asplund; Bo Carlberg; Per-Gunnar Wiklund; Aase Wisten; Signild Åsberg; Marie Eriksson

doi:10.1161/STROKEAHA.115.009087

Antithrombotic Treatment Following Intracerebral Hemorrhage in Patients With and Without Atrial Fibrillation

Stroke. 2015 Aug;46(8):2094-9. doi: 10.1161/STROKEAHA.115.009087. Epub 2015 Jul 9.

Authors

Johanna Pennlert¹, Kjell Asplund², Bo Carlberg², Per-Gunnar Wiklund², Aase Wisten², Signild Åsberg², Marie Eriksson²

Affiliations

¹ From the Department of Public Health and Clinical Medicine and Department of Medicine (J.P., K.A., B.C., P.-G.W.), Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit (A.W.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Uppsala University, Sweden (S.Å.). johanna.pennlert@vll.se.
² From the Department of Public Health and Clinical Medicine and Department of Medicine (J.P., K.A., B.C., P.-G.W.), Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit (A.W.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Uppsala University, Sweden (S.Å.).

PMID: 26159794
DOI: 10.1161/STROKEAHA.115.009087

Abstract

Background and purpose: Patients who survive intracerebral hemorrhage (ICH) often have compelling indications for anticoagulant and antiplatelet medication. This nationwide observational study aimed to determine the extent and predictors of antithrombotic treatment after ICH in Sweden.

Methods: Patients with a first-ever ICH in the Swedish Stroke Register (Riksstroke) 2005 to 2012 who survived hospital discharge were included. Riksstroke data were individually linked with other national registers to determine comorbid conditions and dispensed prescriptions of antithrombotic agents.

Results: Among the 2777 patients with atrial fibrillation (AF), the proportion with a dispensed prescription of antithrombotic agents was 8.5% (anticoagulants) and 36.6% (antiplatelet agents) within 6 months and 11.1% (anticoagulants) and 43.6% (antiplatelet agents) within 1 year. Among the 11 268 patients without AF, the corresponding figures were 1.6% (anticoagulants) and 13.8% (antiplatelet agents) within 6 months and 2.0% (anticoagulants) and 17.5% (antiplatelet agents) within 1 year. In patients with AF, predictors of anticoagulant treatment were less severe ICH, younger age, previous anticoagulation, valvular disease, and previous ischemic stroke. High CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke [doubled], vascular disease, age, and sex category [female]) scores did not correlate with anticoagulant treatment. There was a positive correlation between high CHA2DS2-VASc and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol) scores (rs=0.590, P<0.001).

Conclusions: In majority of patients who receive antithrombotic agents, treatment is initiated within 6 months of ICH. Still, many patients with compelling indications for antithrombotic treatment are not prescribed antithrombotic agents. Factors other than high risk of embolic stroke by CHA2DS2-VASc in ICH survivors with concurrent AF are used to guide the anticoagulant treatment decision in Swedish clinical practice.

Keywords: anticoagulation; antiplatelet agent; atrial fibrillation; intracerebral hemorrhage.

Publication types

Comparative Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Atrial Fibrillation / diagnosis
Atrial Fibrillation / drug therapy*
Atrial Fibrillation / epidemiology*
Cerebral Hemorrhage / diagnosis
Cerebral Hemorrhage / drug therapy*
Cerebral Hemorrhage / epidemiology*
Female
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Humans
Male
Middle Aged
Registries
Sweden / epidemiology
Treatment Outcome
Young Adult

Substances

Fibrinolytic Agents