Abstract TP116: Procoagulant Reversal Of Warfarin After Intracranial Hemorrhage Is Not Associated With Improved Functional Outcome When Coagulation Is Abnormal Without Full Anticoagulation

Abstract

Introduction: Although the current guidelines recommend procoagulant reversal of elevated INR >= 2.0 (International Normalized Ratio) in patients with intracranial hemorrhage using warfarin, the benefit of procoagulant reversal is uncertain when patients have abnormal coagulation but are not fully anticoagulated. Hypothesis: For patients using warfarin (INR 1.5 to 1.9) who have intracranial hemorrhage the use of procoagulant reversal will improve functional outcome based upon dichotomized discharge mRS (modified Rankin scale) 0-3 vs 4-6. Methods: The Get With The Guidelines - Stroke registry was used to identify 239,681 patients with intracranial hemorrhage from hospitals using the comprehensive stroke center form between January 1, 2015 and January 4, 2022. Patients were excluded if they received thrombolytics, were using direct oral anticoagulants, if INR was not between 1.5 and 1.9, or if they were not using warfarin. To evaluate the association between procoagulant reversal and mRS at discharge, 1868 patients with non-missing mRS were analyzed for the primary outcome (mRS 0-3 vs. 4-6). Secondary outcomes that did not require mRS were analyzed among a possible 2569 patients. Propensity scores were estimated and overlap weighting was used to account for confounding. Logistic and negative binomial regression models were fit for binary and count variables, respectively. Results: There was an even distribution of patients into treatment and nontreatment (N=974 no reversal, N=894 reversal), and the groups were strikingly similar. Key outcomes are shown in the Table. Conclusions: Procoagulant reversal of warfarin for patients with acute intracranial hemorrhage and INR 1.5 - 1.9 was not associated with an improvement in functional outcome based upon mRS 0-3 vs 4-6. Patients that received a reversal agent had 25% lower odds of dying in the hospital or being discharged to hospice, but had a longer hospital stay and were less likely to be fully ambulatory at discharge.