PCV31 - ANTICOAGULANTS IN OLDER PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION AFTER INTRACRANIAL HEMORRHAGE

Abstract

Patients with non-valvular atrial fibrillation (NVAF) who survive an intracranial hemorrhage (ICH) have an increased risk of ischemic stroke and systemic emboli (IS/SE). We investigated whether starting oral anticoagulants (OAC) among older NVAF patients after an ICH was associated with a lower risk of IS/SE and mortality, but offset by an increase in major bleeding. Cohort study assembled from administrative data from the Quebec RAMQ and Med-Echo databases. We identified older adults (> 65 years) with NVAF from 1995 to 2015 who were discharged in the community. All patients with incident ICH were included. Patients were categorized as no or OAC exposure. Outcomes included IS/SE, all-cause mortality, recurrent ICH and other major bleeding after a quarantine period of 6 weeks. Crude event rates were calculated at 1-year of follow-up, and Cox proportional Hazard models and a time-dependent binary exposure were used to calculate adjusted HRs (AHR). Cohort of 681 NVAF patients with ICH aged 83 years on average. The rate (per 100 person-years) for IS/SE, death, ICH and major bleeding were 3.3, 40.6, 11.4 and 2.7 for the no OAC group; and 2.6, 16.3, 5.2 and 5.2 for OAC group, respectively. The AHR for IS/SE and death was 0.23 (0.14-0.39) (95% confidence interval), 0.40 (0.18-0.89) for recurrent ICH and 2.26 (0.96-5.36) for major bleeding comparing OAC exposure to non-exposed. Initiating OAC after ICH in older individuals with NVAF is associated with a reduction of IS/SE and mortality as well as recurrent ICH supporting it’s use after ICH.