Resuming warfarin after intracranial hemorrhage in patients with AF was linked to reduced mortality

Question

What are the risks associated with resuming warfarin treatment after a hemorrhagic stroke or traumatic intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF)?

Methods

Design

Cohort study using linkage of national patient, prescription, and vital statistics registries between 1998 and 2016. Median follow-up was 279 days.

Setting

Denmark.

Patients

2415 patients (mean age 77 y, 61% men) who had incident AF, were treated with warfarin in the 6 months before a subsequent ICH event (index event; spontaneous hemorrhagic stroke [n = 1325] or trauma-induced ICH [n = 1090]), and were alive 14 days after discharge from hospital.

Risk factors

Filled prescriptions for warfarin after index ICH event. Analyses were adjusted for age, sex, CHA₂DS₂-VASc score, HAS-BLED score, previous thromboembolism, vascular disease, hypertension, diabetes, aspirin, β-blockers, nonsteroidal antiinflammatory drugs, statins, and days in hospital from the index event.

Outcomes

Outcomes included subsequent stroke (ischemic or hemorrhagic events) and all-cause mortality.

Main result

The main results are in the Table.

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Conclusions

In patients with atrial fibrillation who had a spontaneous hemorrhagic stroke, resuming warfarin was not linked to ischemic or hemorrhagic stroke but was linked to reduced all-cause mortality. In those with trauma-induced intracranial hemorrhage, resuming warfarin was linked to reduced stroke events and all-cause mortality.