Abstract 131: Impact of Concomitant Use of Antiplatelet and Anticoagulation Therapies on Outcomes in Patients With Intracerebral Hemorrhage

Abstract

Background: The impact of the preceding use of concomitant use of antiplatelet and anticoagulation therapies on outcomes of intracerebral hemorrhage (ICH) has not been thoroughly investigated. Methods: We analyzed 138,834 patients presenting with ICH between October 2013 and December 2016 from 1661 hospitals participating in the Get With The Guidelines-Stroke program. Multivariable logistic regression was used to evaluate the impact of concomitant antiplatelet therapy on in-hospital mortality in anticoagulation-related ICH. Results: Of 138,834 patients (mean [SD] age 68.4 [15.3] years; 48.0% women), 118,219 (85.2%) patients were not receiving any oral anticoagulant (OAC), 15,777 (11.4%) were receiving warfarin and 4,838 (3.5%) were receiving non-vitamin K oral anticoagulants (NOACs) prior to ICH. Stroke severity as measured by NIHSS was similar across three groups. Patients receiving warfarin or NOACs were more likely to have single antiplatelet therapy (SAPT) than those receiving no OAC (33.0% for warfarin, 30.7% for NOACs, and 27.3% for no OAC), whereas patients receiving no OAC were more likely to have dual antiplatelet therapy (DAPT) (2.5% for warfarin, 2.3% for NOACs, and 4.4% for no OAC). After adjustment for confounders, SAPT was associated with a slightly higher rate of mortality (33.8% vs. 32.1%, adjusted odds ratio [AOR] = 1.20, 95% CI [1.11-1.30]) than no antiplatelet in patients receiving warfarin, whereas there were no statistically significant differences between SAPT vs. no antiplatelet in patients with no OAC (22.4% vs. 22.9%, AOR = 0.99 [0.95-1.03]) or NOACs (26.8% vs. 26.9%, AOR = 1.09 [0.94-1.26]). DAPT was associated with increased risk of death in patients taking warfarin (46.5% vs. 32.1%, AOR = 2.08 [95% CI, 1.68-2.57]) and no OAC (30.4% vs. 22.9%, AOR = 1.51 [95% CI, 1.40-1.63]). By contrast, in patients taking NOACs, the association of DAPT was not significant but the confidence intervals were wider (32.7% vs. 26.9%, AOR = 1.37 [95% CI, 0.90-2.08]) likely due to small sample size. Conclusions: In patients experienced an ICH, prior concomitant use of antiplatelet therapy (either SAPT or DAPT) significantly increased odds of mortality in patients taking warfarin, but such a difference was not apparent in NOAC-treated ICH patients.