Abstract P023: Predictors of Oral Anticoagulation Resumption Among Atrial Fibrillation Patients Surviving an Intracranial Hemorrhage

Abstract

Background: The clinical benefit of resuming oral anticoagulation (OAC) in atrial fibrillation (AF) patients who have survived an intracranial hemorrhage (ICH) remains unclear. It is important to understand what patient characteristics affect whether patients are restarted on OAC after an ICH. Hypothesis: We hypothesized that younger patients, those without chronic kidney disease, and at high stroke risk would be more likely to restart OAC. Methods: Using claims data from a 5% random sample of Medicare beneficiaries, we selected patients with a diagnosis of non-valvular AF who experienced an ICH while using OAC (n=4,822). The primary outcome was OAC resumption at 12 weeks after ICH. Among patients who restarted OAC, we further evaluated the likelihood of resuming warfarin versus direct oral anticoagulants (DOACs). We constructed multivariate logistic regression to evaluate the association between a comprehensive list of demographics and clinical characteristics (list in table) and OAC resumption. Results: Among the 4,822 patients, 1,766 (37%) restarted OAC during the first 12 weeks. Among them, 280 (16%) started direct oral anticoagulants, and 1,486 (84%) started warfarin. Younger patients, those eligible for Medicaid, with a previous ischemic stroke and higher CHA 2 DS 2 -VASc score were more likely to restart OAC (Table). Among participants who resumed OAC in 12 weeks, patients with a history of ischemic stroke were less likely to use DOACs; however, those with a higher risk of bleeding, measured by HAS-BLED score, were more likely to use them. Conclusion: Around 35% of AF patients who survived an ICH restarted OAC within 12 weeks of the ICH, and, among them, most used warfarin. Although a history of ischemic stroke increased the odds of OAC resumption, it decreased the odds of using DOACs.