Resumption of oral anticoagulation in patients with non-valvular atrial fibrillation after intracerebral hemorrhage: A sub-analysis of the PASTA registry study

Satoshi Suda; Yasuyuki Iguchi; Yoshiki Yagita; Takao Kanzawa; Seiji Okubo; Shigeru Fujimoto; Yu Kono; Kazumi Kimura; PASTA Investigators

doi:10.1016/j.jns.2023.120810

Resumption of oral anticoagulation in patients with non-valvular atrial fibrillation after intracerebral hemorrhage: A sub-analysis of the PASTA registry study

J Neurol Sci. 2023 Oct 15:453:120810. doi: 10.1016/j.jns.2023.120810. Epub 2023 Sep 14.

Authors

Satoshi Suda¹, Yasuyuki Iguchi², Yoshiki Yagita³, Takao Kanzawa⁴, Seiji Okubo⁵, Shigeru Fujimoto⁶, Yu Kono⁷, Kazumi Kimura⁸; PASTA Investigators

Affiliations

¹ Department of Neurology, Nippon Medical School, Tokyo, Japan; Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan. Electronic address: sudasa@saitama-med.ac.jp.
² Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
³ Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
⁴ Department of Stroke Medicine, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Gunma, Japan; Institute of HM Network, Gunyukai Isesaki Clinic, Gunma, Japan.
⁵ Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan.
⁶ Division of Neurology, Department of Medicine, Jichi Medical University Hospital, Tochigi, Japan.
⁷ Department of Neurology, Fuji City General Hospital, Shizuoka, Japan.
⁸ Department of Neurology, Nippon Medical School, Tokyo, Japan.

PMID: 37742350
DOI: 10.1016/j.jns.2023.120810

Abstract

Purpose: To investigate the rate and timing of oral anticoagulant (OAC) resumption and its safety in patients after intracerebral hemorrhage (ICH) in current clinical practice in Japan.

Methods: We conducted a sub-analysis of the PASTA registry, an observational, multicenter registry of 1043 patients with stroke receiving OACs in Japan, by including patients with ICH on OAC treatment for non-valvular atrial fibrillation (NVAF). The clinical characteristics of the patients in the resumption and non-resumption groups, rate and timing of OAC resumption, its safety, and switching of OACs after ICH were investigated.

Results: Of the 160 patients (women, n = 52; median age, 77 years) included, OACs were resumed in 108 (68%) at a median of 7 days (interquartile range, 4-11) after acute ICH onset. The non-resumption group had higher rates of hematoma expansion (21.2% vs. 7.4%; P = 0.0118) and modified Rankin Scale (mRS) scores at discharge (4 (Suda et al., 2019; Steiner et al., 2014 [3, 4]) vs. 4 (Suda et al., 2019; Steiner et al., 2014; Pasquini et al., 2014 [3-5]); P = 0.0302}. The resumption rate in the mRS 0-4 group was higher than that in the mRS 5 group (75.2% vs. 46.5%; P = 0.00006). The number of days to resumption after ICH onset was longer in the mRS 5 than that in the mRS 0-4 group (median 12 days vs. 7 days, P = 0.0065). There were no significant differences in new-onset ICH, symptomatic hematoma expansion, or gastrointestinal bleeding between groups (P > 0.05).

Conclusions: Early resumption of OAC for NVAF in patients after ICH appeared to be safe. Expected functional outcomes at discharge were associated with OAC resumption and with the timing of resumption.

Registration: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034958.

Keywords: Atrial fibrillation; Direct oral anticoagulants; Intracerebral hemorrhage; Oral anticoagulants; Resumption.