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Circulation. 2016 Apr 19;133(16):1540-7. doi: 10.1161/CIRCULATIONAHA.115.019794. Epub 2016 Mar 11.

Use of Oral Anticoagulants for Stroke Prevention in Patients With Atrial Fibrillation Who Have a History of Intracranial Hemorrhage.

Author information

1
From Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (T.-F.C., J.-N.L., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-C.T., F.-P.C., S.-A.C.); Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (T.-F.C., J.-N.L., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-C.T., F.-P.C., S.-A.C.); Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-J.L.); Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan (C.-J.L.); Department of Family Medicine, Taipei Veterans General Hospital, Taiwan (T.-J.C.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.).
2
From Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (T.-F.C., J.-N.L., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-C.T., F.-P.C., S.-A.C.); Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (T.-F.C., J.-N.L., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-C.T., F.-P.C., S.-A.C.); Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-J.L.); Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan (C.-J.L.); Department of Family Medicine, Taipei Veterans General Hospital, Taiwan (T.-J.C.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.). epsachen@ms41.hinet.net.

Abstract

BACKGROUND:

The risk of further intracranial hemorrhage (ICH) and the benefit of stroke risk reduction with the use of oral anticoagulants for patients who have atrial fibrillation with a history of ICH remain unclear. We aimed to investigate the risks and benefits in patients who have atrial fibrillation with a previous ICH treated with warfarin or antiplatelet drugs in comparison with no antithrombotic therapies.

METHODS AND RESULTS:

This study used the National Health Insurance Research Database in Taiwan. Among 307 640 patients who have atrial fibrillation with a CHA2DS2-VASc score ≧2, 12 917 patients with a history of ICH were identified and were assigned to 1 of 3 groups, that is, no treatment, antiplatelet therapy, and warfarin. Among patients with previous ICH, the rate of ICH and ischemic stroke in untreated patients was 4.2 and 5.8 per 100 person-years, respectively. The annual ICH and ischemic stroke rates in warfarin users were 5.9% and 3.4%, respectively. Among users of antiplatelet agents, the rates were 5.3% per year and 5.2% per year, respectively. The number needed to treat for preventing 1 ischemic stroke was lower than the number needed to harm for producing 1 ICH with warfarin use for patients with a CHA2DS2-VASc score ≧6 (37 versus 56). The number needed to treat was higher than the number needed to harm for patients with a CHA2DS2-VASc score <6 (63 versus 53).

CONCLUSIONS:

Warfarin use may be beneficial for patients who have atrial fibrillation with a previous ICH having a CHA2DS2-VASc score ≧6. Whether the use of non-vitamin K antagonist oral anticoagulants could lower the threshold for treatment deserves further study.

KEYWORDS:

CHA2DS2-VASc score; atrial fibrillation; intracranial hemorrhages; stroke

[Indexed for MEDLINE]

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