Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: Intracerebral hemorrhage related to oral anticoagulation is associated with high morbidity and mortality. Although rapid reversal of anticoagulation is recommended to improve outcomes, evidence supporting an optimal time frame remains limited.
Methods: This retrospective, multicenter analysis evaluated the association between door to treatment time (DTT) and hemostatic efficacy following reversal in patients who presented with anticoagulation-associated intracranial hemorrhage between August 1st, 2022, and December 31st, 2024. Hemostatic efficacy was assessed using radiographic hematoma expansion, neurologic deterioration, and the need for advanced interventions. Groups were stratified based on a DTT within 60 minutes or greater than 60 minutes. Secondary outcomes included hospital length of stay (LOS), intensive care unit (ICU) LOS, in-hospital mortality, and discharge disposition.
Results: A total of 186 patients were included in the study, 42 patients with a DTT of within 60 minutes and 144 patients with DTT of greater than 60 minutes. At baseline, patients reversed within 60 minutes had significantly more diagnoses of intracerebral hemorrhage (83% versus 42%, p< 0.001), lower baseline Glasgow Coma Scale scores (14 [IQR 11-15] versus 15 [14-15], p= 0.005), higher rates of intubation (40% versus 17%, p< 0.001), and higher systolic blood pressure (160 mmHg [IQR 148-179] versus 145 mmHg [IQR 130-163], p< 0.001). Results demonstrated significantly higher rates of hemostatic efficacy in the group of patients reversed after 60 minutes (60% vs 43%, p= 0.043), however, this was likely explained by the higher requirement for intubation in the less than 60-minute group, which was independently associated with poor hemostatic efficacy (adjusted odds ratio 0.015, 95% CI 0.002-0.114). In-hospital mortality was also higher with a DTT of within 60 minutes (40% vs 13%, p< 0.001).
Conclusions: In this analysis, anticoagulation reversal within 60 minutes was associated with both lower hemostatic efficacy and higher in-hospital mortality, however, these findings were likely reflective of higher illness severity at presentation rather than DTT. Prospective studies are needed to determine the optimal reversal timeframe for anticoagulation-associated intracranial hemorrhage.
