Abstract 145: Anticoagulation-Related Intracerebral Hemorrhage and Time to Reversal Treatment After Intracerebral Hemorrhage in the United States

Abstract

Background: Anticoagulation-associated intracerebral hemorrhage (AC-ICH) often results in death. Specific reversal agents are available, but it is not clear whether there is a time-dependent treatment effect. We characterized patients with AC-ICH and investigated the relationship between time to treatment and outcome. Methods: We analyzed data from 9492 AC-ICH patients who presented within 24 hours of onset across 465 hospitals reporting any anticoagulation reversal treatment in GWTG-Stroke from 2015 to 2021. For patients with available door-to-treatment (DTT) times, outcomes were analyzed using logistic regression models adjusted for demographic, history, baseline, and hospital characteristics. A spline plot for mortality was generated for DTT and in-patient mortality from the adjusted predicted outcome probability. Results: Among 9492 patients admitted within 24h of AC-ICH, the median age was 77 years, 45% female, and NIHSS median 11. 79% (7469) received reversal treatment and 21% (2143) did not. Among reversal patients, pretreatment AC was warfarin in 62.2% and a direct oral anticoagulant in 37.8%. For 5224 patients with documented times, median onset to treatment time was 232 (IQR 142-185) minutes and DTT was 82 (58-117) mins, with DTT ≤60m for 27.7%. DTT ≤60 minutes was associated with lower odds of mortality than a DTT of >61-180 minutes (aOR 0.83 [95% CI: 0.69-1.00]). Factors associated with DTT ≤ 60 minutes include white non-Hispanic race, higher blood pressure, lower NIHSS, and a larger hospital size. Spline plotting showed a steep mortality increase with longer DTT in the first 30-minutes post-arrival (Figure). Conclusion: In US hospitals participating in GWTG-Stroke reporting reversal therapy, most patients with AC-ICH received reversal agents. Earlier administration was associated with improved survival. These findings support intensive efforts to accelerate evaluation and treatment for patients with this devastating form of stroke.