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. 2024 Dec 5:16:837-848.
doi: 10.2147/CLEP.S493499. eCollection 2024.

Association of Prior Antithrombotic Drug Use with 90-Day Mortality After Intracerebral Hemorrhage

Christian Mistegård Jørgensen  1 , Nils Jensen Boe  1 , Stine Munk Hald  1 , Frederik Meyer-Kristensen  1 , Mie Micheelsen Norlén  1 , Christian Ovesen  1   2 , Sören Möller  3   4 , Birgit Bjerre Høyer  3 , Jonas Asgaard Bojsen  5 , Mohammad Talal Elhakim  5 , Frederik Severin Gråe Harbo  5 , Rustam Al-Shahi Salman  6 , Larry B Goldstein  7 , Jesper Hallas  8 , Luis Alberto García Rodríguez  9 , Magdy Selim  10 , David Gaist  1
Affiliations

Association of Prior Antithrombotic Drug Use with 90-Day Mortality After Intracerebral Hemorrhage

Christian Mistegård Jørgensen et al. Clin Epidemiol. .

Abstract

Purpose: To estimate the strength of association between use of antithrombotics (AT) drugs with survival after spontaneous intracerebral hemorrhage (s-ICH) comparing oral anticoagulant (OAC) or platelet antiaggregants (PA) with no AT use and in active comparator analyses OAC vs PA, direct oral anticoagulant (DOAC) vs vitamin K antagonist (VKA), and clopidogrel vs aspirin.

Patients and methods: We identified patients ≥55 years with a first-ever s-ICH between 2015 and 2018 in Southern Denmark (population 1.2 million). From this population, patients who had used an AT at the time of ICH were identified and classified as OAC or PA vs no AT (reference group), and for active comparator analyses as OAC vs PA (reference group), DOAC vs VKA (reference group), or clopidogrel vs aspirin (reference group). We calculated adjusted relative risks (aRRs) and corresponding [95% confidence intervals] for 90-day all-cause mortality with adjustments for potential confounders.

Results: Among 1043 patients who had s-ICH, 206 had used an OAC, 270 a PA, and 428 had no AT use. The adjusted 90-day mortality was higher in OAC- (aRR 1.68 [1.39-2.02]) and PA-users (aRR 1.21 [1.03-1.42]), compared with no AT. Mortality was higher in OAC- (aRR 1.19 [1.05-1.36]) vs PA-users. In analyses by antithrombotic drug type, 88 used a DOAC, 136 a VKA, 111 clopidogrel, and 177 aspirin. Mortality was lower among DOAC- vs VKA-users (aRR 0.82 [0.68-0.99]), but similar between clopidogrel vs aspirin users (aRR 1.04 [0.87-1.24]).

Conclusion: In this unselected cohort from a geographically defined Danish population, 90-day mortality after s-ICH was higher in patients with prior use of an OAC compared with no AT use or patients using a PA. Mortality was slightly lower for patients using a DOAC than a VKA. Mortality was also higher in PA- vs no AT-users, but there were no differences in mortality between clopidogrel vs aspirin.

Keywords: intracerebral hemorrhage; oral anticoagulants; platelet antiaggregants; stroke; stroke prevention.

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Conflict of interest statement

Dr Christian Ovesen is a shareholder of Novo Nordisk. Dr Jonas Bojsen reports grants from Innovation Fund Denmark, outside the submitted work. Professor Rustam Al-Shahi Salman reports grants from British Heart Foundation paid to The University of Edinburgh for ASPIRIN. Professor Jesper Hallas reports grants from Novo Nordisk, Leo Pharma, Roche, Pfizer, and Astellas, outside the submitted work. Dr Luis García Rodríguez works for CEIFE, which received research grants from Bayer for research projects outside the submitted work. Professor David Gaist reports personal fees from Pfizer and Bristol Myers Squibb, and participated in research works funded by Bayer paid to his institution, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study flow-chart.
Figure 2
Figure 2
Crude cumulative incidence of all-cause death after ICH during 90 days of follow-up by class and type of prior antithrombotic use. Changes in number at risk/cumulative events <5 not reported (NR) to comply with cell suppression policy. (A) Comparison between antithrombotic classes. (B) Comparison between direct oral anticoagulants vs vitamin K antagonist. (C) Comparison between clopidogrel and aspirin.
See this image and copyright information in PMC

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