553: COMPARISON OF INTRACRANIAL HEMATOMA EXPANSION IN PATIENTS ON WARFARIN VS. DIRECT ORAL ANTICOAGULANTS

Abstract

Introduction: Anticoagulation associated intracranial hemorrhage has been associated with larger initial hematoma volumes and a greater frequency of hematoma expansion. Preventing hematoma expansion is a promising treatment strategy as expansion is a predictor of poor outcomes. Limited studies have been conducted that directly compare hematoma expansion in patients taking warfarin versus direct oral anticoagulants (DOACs). Due to increased prescribing of DOACs, this study aimed to assess intracranial hematoma expansion in patients taking warfarin compared to DOACs. Methods: This was a retrospective, observational study conducted at an academic, adult level one trauma, and comprehensive stroke center between October 1, 2016 and November 30, 2021. Adult patients were included if they were diagnosed with a primary intracranial hemorrhage, prescribed warfarin or DOACs prior to admission, admitted to an intensive care unit (ICU), and had an initial and follow-up computed tomography (CT) brain within 24 hours. The primary outcome was incidence of hematoma expansion upon repeat CT brain. Secondary outcomes included hospital and ICU length of stay (LOS), incidence and duration of mechanical ventilation, in-hospital mortality, incidence and type of thrombotic complications during hospital stay, and discharge disposition. Results: Of the 56 patients included, 29 were on warfarin and 27 were on a DOAC. Hematoma expansion occurred in 8 (27.6%) warfarin and 9 (33.3%) DOAC patients (P=0.640). Patients in the DOAC group had a significantly shorter ICU LOS (2.7 ± 2.3 vs 4.7 ± 4.1 days; P=0.033) and hospital LOS (6.0 ± 4.9 vs 9.4 ± 6.1; P=0.028) compared to the warfarin group. Additionally, 7 (24.1%) warfarin patients were discharged to hospice compared to 0 (0.0%) in the DOAC group (P=0.011). No other significant differences were observed. Conclusions: There was no statistically significant difference in the incidence of hematoma expansion between groups. However, a shorter ICU and hospital LOS was demonstrated in the DOAC group.