335 AN AUDIT OF ANTI-COAGULATION AND ANTI-PLATELET PRESCRIBING POST-INTRACEREBRAL HEMORRHAGE

Abstract

Abstract Background Choosing if, and when antithrombotic therapy should be re-started after Intracerebral Haemorrhage (ICH) is a decision commonly faced by clinicians working in stroke medicine. In spite of this, there is a dearth of international guidelines to support clinicians in decision making. Two recent Randomised-Controlled Trials (RCT), RESTART and SO-START, have indicated that anti-thrombotic therapy may have a better benefit:risk ratio than previously thought for patients post ICH. We conducted an audit of our practice in our tertiary hospital in 2020, a centre dealing with acute stroke. Methods Data was sourced from the local HIPE repository and included patients with acute, spontaneous ICH. Data was examined for variables which may influence decision to re-introduce anti-thrombotics such as indication for anti-thrombotic, type of anti-thrombotic, length of time to re-start anti-thrombotic post ICH, survival at discharge, and follow-up imaging. Our practice was compared to the intervention arms of the two previously mentioned RCT's. Results Of 56 included patients, 42 patients (75%) survived to discharge. Chi-squared analysis was used to assess for associations between variables. Of patients taking anti-platelets at time of ICH, only 25% were restarted on anti-platelet therapy at one year. Mean time to restarting anti-platelets post ICH was 20 weeks. For patients on oral anti-coagulation, 70% were restarted on oral anti-coagulation at one year. Mean time post ICH for restarting oral-anticoagulation was 14 weeks. No patients with amyloid angiopathy confirmed on MR Brain (n=5), were restarted on anti-thrombotic therapy, which was statistically significant. (p<0.01). Conclusion Results of our audit revealed a smaller proportion of patients were re-started on anti-platelet therapy compared to anti-coagulant therapy, despite trial evidence suggesting both are reasonable options for patients post ICH. Confirmed amyloid angiopathy was associated with a reduced rate of re-starting anti-thrombotic therapy. Further research is needed to examine outcomes amongst those restarted on antithrombotic therapy and to develop practice guidelines in this area.