Decrease in incidence of oral anticoagulant-related intracerebral hemorrhage over the past decade in the Netherlands

Peeters, Michaël T.J.; Vroman, Florence; Schreuder, Tobien AHCML; Oostenbrugge, Robert J. van; Staals, Julie

doi:10.1177/23969873211062011

Cited by 5 publications

(8 citation statements)

References 30 publications

(71 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, a meta-analysis by Li et al [8] from 2022 found no significant temporal trend in ICH incidence between 1996 and 2017 in high-and upper middle-income countries. A regional population-based study on OAC ICH incidence from the Netherlands showed a significant decline in OAC ICH incidence despite an increased number of OAC users between 2007-2009 and 2017-2019 [17], whereas our data showed a 56% increase in OAC ICH incidence. However, the initial proportion of OAC ICH in the Dutch study was with 25.8% almost twice as high compared to our results (13.1% 2010-2012 in Sweden) which might explain the opposite trend in OAC ICH incidence.…”

Section: Discussioncontrasting

confidence: 89%

“…At the same time the proportion of especially older AF-patients treated with OAC has increased [14], not least because of the introduction of non-vitamin K oral anticoagulants (NOACs) which are associated with a lower risk for ICH compared to treatment with vitamin K antagonists (VKA) [15]. All these factors might influence trends in ICH incidence, but recent studies have shown diverging results, also in OAC-associated ICH incidence [16, 17]. The aim of this register-based, nationwide study was to analyze trends in first-ever ICH incidence in Sweden between 2010 and 2019 with focus on non-OAC and OAC-associated ICH.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010–2019: An Observational Study from the Swedish Stroke Register (Riksstroke)

Drescher,

Buchwald,

Ullberg

et al. 2023

Neuroepidemiology

View full text Add to dashboard Cite

Introduction: Although ischemic stroke incidence has decreased in Sweden over the past decade, trends in spontaneous intracerebral hemorrhage (ICH) incidence are less well delineated. In this time period, there has been a dramatic increase in use of oral anticoagulants (OAC). The aim of our study was to investigate incidence trends in spontaneous first-ever ICH in Sweden between 2010 and 2019, with a focus on non-OAC-associated and OAC-associated ICH. Methods: We included patients (≥18 years) with first-ever ICH registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010–2019. Data were stratified by non-OAC and OAC ICH and analyzed for 2010–2012, 2013–2016, and 2017–2019. Incidence rates are shown as crude and age-specific per 100,000 person-years. Results: Between 2010 and 2019, 22,289 patients with first-ever ICH were registered; 18,325 (82.2%) patients with non-OAC ICH and 3,964 (17.8%) patients with OAC ICH. Annual crude incidence (per 100,000) of all first-ever ICH decreased by 10% from 29.5 (95% CI 28.8–30.3) to 26.7 (95% CI 26.0–27.3) between 2010–2012 and 2017–2019. The crude incidence rate of non-OAC ICH decreased by 20% from 25.7 (95% CI 25.0–26.3) to 20.7 (95% CI 20.1–21.2), whereas OAC ICH increased by 56% from 3.86 (95% CI 3.61–4.12) to 6.01 (95% CI 5.70–6.32). The proportion of OAC ICH of all first-ever ICH increased between 2010–2012 and 2017–2019 from 13.1% to 22.5% (p < 0.001). Proportional changes were largest in the age group ≥85 years with a decrease in non-OAC ICH by 32% from 155 (95% CI 146–164) to 106 (95% CI 98.6–113) and an increase in OAC ICH by 155% from 25.7 (95% CI 22.1–29.4) to 65.5 (95% CI 59.9–71.2). Conclusion: Incidence of first-ever ICH in Sweden decreased by 10% between 2010 and 2019. We found diverging trends with a 20% decrease in non-OAC-associated ICH and a 56% increase in OAC-associated ICH. Further research on ICH epidemiology, analyzing non-OAC and OAC-associated ICH separately, is needed to follow up these diverging trends including underlying risk factors.

show abstract

Section: Discussioncontrasting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010–2019: An Observational Study from the Swedish Stroke Register (Riksstroke)

Drescher,

Buchwald,

Ullberg

et al. 2023

Neuroepidemiology

View full text Add to dashboard Cite

show abstract

“…The incidence of ICH with prior OAC use (OAC-ICH) increased from 0.8 per 100,000 in 1988 to 4.4 per 100,000 in 1999, before DOACs became available in the United States 18 . However, two recent studies from Denmark and the Netherlands showed that the incidence of OAC-ICH was decreasing from before and after DOACs became available (33 or 10.5 per 100,000 person-years to 24 or 7.7 per 100,000 person-years, respectively) 29 , 30 . These findings may reflect DOACs having about a 50% lower risk of intracranial bleeding compared to warfarin in patients with AF 31 .…”

Section: Discussionmentioning

confidence: 99%

Trends in prior antithrombotic medication and risk of in-hospital mortality after spontaneous intracerebral hemorrhage: the J-ICH registry

Ueno,

Tokugawa,

Saito

et al. 2024

Sci Rep

View full text Add to dashboard Cite

Spontaneous intracerebral hemorrhage (SICH) remains a devastating form of stroke. Prior use of antiplatelets or warfarin before SICH is associated with poor outcomes, but the effects of direct oral anticoagulants (DOACs) remain unclear. This study aimed to clarify trends in prior antithrombotic use and to assess the associations between prior use of antithrombotics and in-hospital mortality using a multicenter prospective registry in Japan. In total, 1085 patients were analyzed. Prior antithrombotic medication included antiplatelets in 14.2%, oral anticoagulants in 8.1%, and both in 1.8%. Prior warfarin use was significantly associated with in-hospital mortality (odds ratio [OR] 5.50, 95% confidence interval [CI] 1.30–23.26, P < 0.05) compared to no prior antithrombotic use. No such association was evident between prior DOAC use and no prior antithrombotic use (OR 1.34, 95% CI 0.44–4.05, P = 0.606). Concomitant use of antiplatelets and warfarin further increased the in-hospital mortality rate (37.5%) compared to warfarin alone (17.2%), but no such association was found for antiplatelets plus DOACs (8.3%) compared to DOACs alone (11.9%). Prior use of warfarin remains an independent risk factor for in-hospital mortality after SICH in the era of DOACs. Further strategies are warranted to reduce SICH among patients receiving oral anticoagulants and to prevent serious outcomes.

show abstract

“…Remarkably, in South Limburg, in the Netherlands ( 68 ), in the period between 2007 and 2009, 25.8% of total ICH (168 of 652) have been associated with OACs use in patients on VKA. An annual incidence of 40.9 total ICH and 10.5 OAC-related ICH per 100,000 people has been reported.…”

Section: Discussionmentioning

confidence: 99%

Management of oral anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation

Lucà

Colivicchi

Oliva

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Intracranial hemorrhage (ICH) is considered a potentially severe complication of oral anticoagulants (OACs) and antiplatelet therapy (APT). Patients with atrial fibrillation (AF) who survived ICH present both an increased ischemic and bleeding risk. Due to its lethality, initiating or reinitiating OACs in ICH survivors with AF is challenging. Since ICH recurrence may be life-threatening, patients who experience an ICH are often not treated with OACs, and thus remain at a higher risk of thromboembolic events. It is worthy of mention that subjects with a recent ICH and AF have been scarcely enrolled in randomized controlled trials (RCTs) on ischemic stroke risk management in AF. Nevertheless, in observational studies, stroke incidence and mortality of patients with AF who survived ICH had been shown to be significantly reduced among those treated with OACs. However, the risk of hemorrhagic events, including recurrent ICH, was not necessarily increased, especially in patients with post-traumatic ICH. The optimal timing of anticoagulation initiation or restarting after an ICH in AF patients is also largely debated. Finally, the left atrial appendage occlusion option should be evaluated in AF patients with a very high risk of recurrent ICH. Overall, an interdisciplinary unit consisting of cardiologists, neurologists, neuroradiologists, neurosurgeons, patients, and their families should be involved in management decisions. According to available evidence, this review outlines the most appropriate anticoagulation strategies after an ICH that should be adopted to treat this neglected subset of patients.

show abstract

Decrease in incidence of oral anticoagulant-related intracerebral hemorrhage over the past decade in the Netherlands

Cited by 5 publications

References 30 publications

Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010–2019: An Observational Study from the Swedish Stroke Register (Riksstroke)

Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010–2019: An Observational Study from the Swedish Stroke Register (Riksstroke)

Trends in prior antithrombotic medication and risk of in-hospital mortality after spontaneous intracerebral hemorrhage: the J-ICH registry

Management of oral anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation

Contact Info

Product

Resources

About