Faster Treatment Improves Survival From Anticoagulation-Associated Intracerebral Hemorrhage

Earlier anticoagulation reversal in patients with anticoagulation-associated intracerebral hemorrhage is associated with improved survival, according to a study published in JAMA Neurology.

“In the present analysis, DTT [door-to-treatment] times of less than 60 minutes most clearly demonstrated a time-dependent effect of coagulopathy reversal, but we cannot exclude an even greater effect with earlier initiation,” wrote corresponding author Kevin N. Sheth, MD, Yale Center for Brain and Mind Health, Yale School of Medicine, New Haven, Connecticut, and study coauthors.

The cohort study included 9492 patients with anticoagulation-associated intracerebral hemorrhage who presented within 24 hours of symptom onset at 465 US hospitals between 2015 and 2021. The median patient age was 77 years. Just over three-quarters of patients received reversal therapy, including 85% of patients taking warfarin and 70.2% taking a non–vitamin K antagonist oral anticoagulant.

Among 5224 patients with a reversal therapy and documented workflow times, the median onset-to-treatment time was 232 minutes and the median DTT time was 82 minutes. Some 27.7% of patients had a DTT time of 60 minutes or less, according to the study.

DTT time of 60 minutes or less was associated with decreased mortality and discharge to hospice, with an adjusted odds ratio of 0.82. Earlier reversal intervention was also associated with increased likelihood of discharge to home or inpatient rehabilitation. However, the study found no difference in functional outcome.

White race, higher systolic blood pressure, and lower stroke severity were all associated with faster administration of reversal therapy. “These findings support intensive efforts to accelerate evaluation and treatment for patients with this devastating form of stroke,” researchers advised.

Reference

Sheth KN, Solomon N, Alhanti B, et al. Time to anticoagulation reversal and outcomes after intracerebral hemorrhage. JAMA Neurol. 2024;81(4):363–72. doi:10.1001/jamaneurol.2024.0221