Introduction: Oral Anticoagulation Treatment (OAT) resumption remains an unresolved question in Intracerebral Hemorrhage (ICH) care. Previous studies focused on the effects of OAT resumption on recurrent stroke.
Hypothesis: OAT resumption is associated with increased likelihood of functional recovery after ICH, even in the absence of symptomatic stroke recurrence.
Methods: We analyzed data for 614 ICH survivors on OAT at time of stroke, who did not experience mortality or recurrent stroke during follow-up, enrolled in three observational studies: 1) the RETRACE study (n=317); 2) a longitudinal ICH study conducted in Boston, USA (n=166); 3) the ERICH study (n=131). We conducted univariable and multivariable analyses of associations between cardioembolic risk (defined by CHA2DS2-VASc score), OAT resumption, and functional recovery after ICH, defined as ≥ 1 point decrease in modified Rankin Scale (mRS) score at one year post-ICH vs. at discharge.
Results: Among 614 participants, 153 (25%) resumed OAT. Individuals resuming OAT differed from those who did not only by higher CHA2DS2-VASc score (p=0.011). CHA2DS2-VASc score was associated with decreased likelihood of functional recovery at 1 year after ICH (Odds Ratio [OR] = 0.73 per 1 point increase, 95% Confidence Interval [CI] = 0.62-0.88, p <0.001). OAT resumption was independently associated with higher likelihood of recovery, regardless of CHA2DS2-VASc score (OR=2.93, 95% CI = 1.25-4.61, p=0.001). Interaction analyses (Figure) clarified that subjects with higher CHA2DS2-VASc score benefited more from OAT resumption in terms of functional recovery (OR = 1.69, 95% CI = 1.20-2.38, p=0.003).
Conclusions: Increasing cardioembolic risk associated with decreased likelihood of functional recovery after ICH. This effect was mitigated by OAT resumption, with greater benefit seen for subjects at high cardioembolic risk. These findings strongly support exploring recovery outcomes in future studies of OAT-ICH.