In the Journals

Mixed outcomes linked with oral anticoagulant therapy in patients with AF, previous intracranial hemorrhage

In patients with atrial fibrillation and a previous history of intracranial hemorrhage, oral anticoagulation was associated with an increased risk for major bleeding and a decreased risk for thromboembolic events, researchers reported in Heart Rhythm.

However, in that patient population, those who started taking oral anticoagulation at least 2 weeks after intracranial hemorrhage and had a time in therapeutic range of at least 60% showed improved clinical outcomes, according to the researchers.

In a retrospective analysis, the researchers compared the rates of thromboembolic and major bleeding events between patients with a history of intracranial hemorrhage who were taking oral anticoagulant therapy (n = 254) with those who were not (n =174).

Patients from the Severance Cardiovascular Hospital in Seoul, Korea were enrolled between January 1, 2009 and December 31, 2013. During a mean follow-up of 34 months, nine patients in the oral anticoagulant therapy group had a thromboembolic event compared with 17 patients in the group who were not on the therapy. The incidence rate of thromboembolic events was 2.4 events per 100 patient-years in the anticoagulant group and 8.3 events per 100 patient-years in the control group (P < .001). Patients on oral anticoagulant therapy also had a higher cumulative thromboembolic event-free survival (P = .001).

In addition, major bleeding events were more common in the oral anticoagulant therapy group than in the control group (20 patients vs. seven patients). The major bleeding event rate was 5.5 events per 100 patient-years in the anticoagulant group and 3.1 events per100 patient-years in the no-anticoagulant group (P = .024) and patients on oral anticoagulant therapy had a lower cumulative survival free of major bleeding events (P = .024).

About half of the major bleeding events and more than half of the central nervous system rebleeding events occurred in patients who were given warfarin within the second week of an intracranial hemorrhage, according to the researchers.

Composite endpoints including thromboembolic events, major bleeding events and all-cause mortality did not differ between the groups (anticoagulant group, 11.5 events per 100 patient-years; no anticoagulant group, 7.9 events per 100 patient-years).

However, the researchers reported that patients taking oral anticoagulation with a time in therapeutic range of at least 60% had a higher rate of cumulative survival free of the composite endpoint vs. patients not taking oral anticoagulation (P < .001).

“Warfarin was used in 76 (30.8%) patients after complete resolution of intracranial bleeding and in 170 (69.1%) patients with suboptimal resolution of intracranial bleeding. Interestingly, while 12 (7%) of 170 patients with suboptimal resolution of acute intracranial bleeding experienced recurrent [central nervous system] bleeding, no patients with a completely resolved intracranial bleeding showed recurrent [central nervous system] bleeding,” the researchers wrote.

According to the researchers, the data reveal that “after confirmation of [intracranial hemorrhage] healing, [oral anticoagulant therapy] with an optimal [international normalized ratio] is beneficial for patients with AF with a history of [intracranial hemorrhage].” by Tracey Romero

Disclosure: The researchers report no relevant financial disclosures.

In patients with atrial fibrillation and a previous history of intracranial hemorrhage, oral anticoagulation was associated with an increased risk for major bleeding and a decreased risk for thromboembolic events, researchers reported in Heart Rhythm.

However, in that patient population, those who started taking oral anticoagulation at least 2 weeks after intracranial hemorrhage and had a time in therapeutic range of at least 60% showed improved clinical outcomes, according to the researchers.

In a retrospective analysis, the researchers compared the rates of thromboembolic and major bleeding events between patients with a history of intracranial hemorrhage who were taking oral anticoagulant therapy (n = 254) with those who were not (n =174).

Patients from the Severance Cardiovascular Hospital in Seoul, Korea were enrolled between January 1, 2009 and December 31, 2013. During a mean follow-up of 34 months, nine patients in the oral anticoagulant therapy group had a thromboembolic event compared with 17 patients in the group who were not on the therapy. The incidence rate of thromboembolic events was 2.4 events per 100 patient-years in the anticoagulant group and 8.3 events per 100 patient-years in the control group (P < .001). Patients on oral anticoagulant therapy also had a higher cumulative thromboembolic event-free survival (P = .001).

In addition, major bleeding events were more common in the oral anticoagulant therapy group than in the control group (20 patients vs. seven patients). The major bleeding event rate was 5.5 events per 100 patient-years in the anticoagulant group and 3.1 events per100 patient-years in the no-anticoagulant group (P = .024) and patients on oral anticoagulant therapy had a lower cumulative survival free of major bleeding events (P = .024).

About half of the major bleeding events and more than half of the central nervous system rebleeding events occurred in patients who were given warfarin within the second week of an intracranial hemorrhage, according to the researchers.

Composite endpoints including thromboembolic events, major bleeding events and all-cause mortality did not differ between the groups (anticoagulant group, 11.5 events per 100 patient-years; no anticoagulant group, 7.9 events per 100 patient-years).

However, the researchers reported that patients taking oral anticoagulation with a time in therapeutic range of at least 60% had a higher rate of cumulative survival free of the composite endpoint vs. patients not taking oral anticoagulation (P < .001).

“Warfarin was used in 76 (30.8%) patients after complete resolution of intracranial bleeding and in 170 (69.1%) patients with suboptimal resolution of intracranial bleeding. Interestingly, while 12 (7%) of 170 patients with suboptimal resolution of acute intracranial bleeding experienced recurrent [central nervous system] bleeding, no patients with a completely resolved intracranial bleeding showed recurrent [central nervous system] bleeding,” the researchers wrote.

According to the researchers, the data reveal that “after confirmation of [intracranial hemorrhage] healing, [oral anticoagulant therapy] with an optimal [international normalized ratio] is beneficial for patients with AF with a history of [intracranial hemorrhage].” by Tracey Romero

Disclosure: The researchers report no relevant financial disclosures.