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Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage

 Young-Ah Park  ;  Jae-Sun Uhm  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
 HEART RHYTHM, Vol.13(9) : 1794-1802, 2016 
Journal Title
Issue Date
Administration, Oral ; Aged ; Anticoagulants/administration & dosage* ; Anticoagulants/adverse effects ; Atrial Fibrillation/complications* ; Female ; Humans ; Intracranial Hemorrhages/chemically induced* ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Stroke/etiology ; Stroke/prevention & control* ; Warfarin/administration & dosage* ; Warfarin/adverse effects
Anticoagulation ; Atrial fibrillation ; Bleeding ; Intracranial hemorrhage ; Thromboembolic events
BACKGROUND: The effect of oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) with a history of intracranial hemorrhage (ICH) is poorly defined.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of OAT in patients with AF with an ICH history.

METHODS: We retrospectively compared the composite end point, including thromboembolic and major bleeding events, between patients with AF with a history of ICH who were (OAT group, n = 254) and those who were not (no-OAT group, n = 174) taking OAT.

RESULTS: During a mean follow-up of 39.5 ± 31.9 months, 5.5 and 3.1 major bleeding events/100 patient-years were observed in the OAT and no-OAT groups, respectively (P = .024). Recurrent ICH was observed only in patient with OAT. Thromboembolic events occurred in 2.4 and 8.3 events/100 patient-years in OAT and no-OAT groups, respectively (P < .001). There was no significant differences in composite end points between OAT and no-OAT groups (11.5 events/100 patient-years vs 7.9 events/100 patient-years; P = .154). Patients with OAT who achieved a time-in-therapeutic range of ≥60% of the international normalized ratio of 2.0-3.0 demonstrated a better cumulative survival free of the composite end point (P < .001) than did patients without OAT. Early (<2 weeks) OAT after an index ICH did not improve composite end points because of the increased incidence of major bleeding events. However, OAT at 2 weeks after an index ICH was associated with decreased clinical events including thromboembolic events and composite end point.

CONCLUSION: In patients with AF who require anticoagulation and have a history of ICH, maintaining optimal OAT with time-in-therapeutic range ≥ 60% and the initiation of OAT at least 2 weeks after an index ICH were associated with improved clinical outcomes.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Young Ah(박영아)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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