Intracranial Hemorrhage Among Patients With Atrial Fibrillation Anticoagulated With Warfarin or Rivaroxaban
Top Cited Papers
- 1 May 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 45 (5), 1304-1312
- https://doi.org/10.1161/strokeaha.113.004506
Abstract
Background and Purpose—: Intracranial hemorrhage (ICH) is a life-threatening complication of anticoagulation. Methods—: We investigated the rate, outcomes, and predictors of ICH in 14 264 patients with atrial fibrillation from Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Cox proportional hazards modeling was used. Results—: During 1.94 years (median) of follow-up, 172 patients (1.2%) experienced 175 ICH events at a rate of 0.67% per year. The significant, independent predictors of ICH were race (Asian: hazard ratio, 2.02; 95% CI, 1.39–2.94; black: hazard ratio, 3.25; 95% CI, 1.43–7.41), age (1.35; 1.13–1.63 per 10-year increase), reduced serum albumin (1.39; 1.12–1.73 per 0.5 g/dL decrease), reduced platelet count below 210×10 9 /L (1.08; 1.02–1.13 per 10×10 9 /L decrease), previous stroke or transient ischemic attack (1.42; 1.02–1.96), and increased diastolic blood pressure (1.17; 1.01–1.36 per 10 mm Hg increase). Predictors of a reduced risk of ICH were randomization to rivaroxaban (0.60; 0.44–0.82) and history of congestive heart failure (0.65; 0.47–0.89). The ability of the model to discriminate individuals with and without ICH was good ( C -index, 0.69; 95% CI, 0.64–0.73). Conclusions—: Among patients with atrial fibrillation treated with anticoagulation, the risk of ICH was higher among Asians, blacks, the elderly, and in those with previous stroke or transient ischemic attack, increased diastolic blood pressure, and reduced platelet count or serum albumin at baseline. The risk of ICH was significantly lower in patients with heart failure and in those who were randomized to rivaroxaban instead of warfarin. The external validity of these findings requires testing in other atrial fibrillation populations.Keywords
This publication has 41 references indexed in Scilit:
- Stroke and Bleeding in Atrial Fibrillation with Chronic Kidney DiseaseThe New England Journal of Medicine, 2012
- A New Risk Scheme to Predict Warfarin-Associated Hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) StudyJournal of the American College of Cardiology, 2011
- The Role of Tissue Factor and Factor VIIa in HemostasisAnesthesia & Analgesia, 2009
- Rivaroxaban – an oral, direct Factor Xa inhibitor – lessons from a broad clinical study programmeEuropean Journal of Haematology, 2009
- Cerebral microbleeds: a guide to detection and interpretationThe Lancet Neurology, 2009
- Death and Disability from Warfarin-Associated Intracranial and Extracranial HemorrhagesAmerican Journal Of Medicine, 2007
- Influence of CYP2C9 and VKORC1 1173C/T Genotype on the Risk of Hemorrhagic Complications in African-American and European-American Patients on WarfarinClinical Pharmacology & Therapeutics, 2007
- Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF)American Heart Journal, 2006
- Risk Factors for Intracerebral Hemorrhage in the General PopulationStroke, 2003
- Blood Coagulation in Patients with Chronic Heart FailureDrugs, 2003