Background: In recent years, direct oral anticoagulants (DOAC) have been approved and included in guidelines as alternatives to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation, in part due to because of better safety profile. Prior to the introduction of DOACs, studies showed that anticoagulation with warfarin carries high risk of bleeding. The goal of this study is to examine the incidence of DOAC- related intracranial bleeding (ICB) in a single center retrospective registry of patients admitted with bleeding events.
Methods: This is a single Centre observational/descriptive study. We identified consecutive patients presenting to a tertiary care stroke center in Ottawa, Canada between Oct 2010-Feb2015 with any bleeding event using ICD-10 criteria. We included patients taking DOACs at the time of admission, and abstracted demographic, clinical, laboratory and outcome data from the medical record.
Results: From a total of 9291 patient presenting with hemorrhage, 100 patients were confirmed to be taking DOACs. Twenty two (22%) patients had ICB (mean age 83years), of whom 6 (27%) were taking Aspirin at time of bleeding. There were 4 intraparenchymal hemorrhages (IPH); (3 spontaneous and 1 traumatic) and the remaining 18 were traumatic SAH and SDH. All patients with ICB were on Dabigatran except one which was on Rivaroxaban. Five of them required reversal agents; 2 received PCC and 3 both PCC and activated PCC. Mean length of stay was 14 days and 12 were discharged to home, 3 to rehabilitation facility, 3 to long term care facility and 4 died. All 4 patients with IPH either died or discharged to long-term care
Conclusion: In this descriptive retrospective study, spontaneous DOAC-related IPH was rare and outcomes following traumatic DOAC-related ICB appear better than spontaneous IPH