Clinical Epidemiology (Dec 2024)

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

  • Jørgensen CM,
  • Boe NJ,
  • Hald SM,
  • Meyer-Kristensen F,
  • Norlén MM,
  • Ovesen C,
  • Möller S,
  • Høyer BB,
  • Bojsen JA,
  • Elhakim MT,
  • Harbo FSG,
  • Al-Shahi Salman R,
  • Goldstein LB,
  • Hallas J,
  • García Rodríguez LA,
  • Selim M,
  • Gaist D

Journal volume & issue
Vol. Volume 16
pp. 837 – 848

Abstract

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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 Gaist1 1Research Unit for Neurology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark; 2Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark; 3Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark; 4Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 5Department of Radiology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark; 6Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; 7Department of Neurology and Kentucky Neuroscience Institute, University of Kentucky, Lexington, KY, USA; 8Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark; 9Centro Español Investigación Farmacoepidemiológica, Madrid, Spain; 10Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USACorrespondence: David Gaist, Research Unit for Neurology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark, Email [email protected]: 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: stroke, intracerebral hemorrhage, stroke prevention, oral anticoagulants, platelet antiaggregants

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