Hipocoagulation in Patients with Atrial Fibrillation and Admitted for Hemorrhagic Stroke

Abstract

Introduction: The stroke prevention strategy in patients
with intracerebral hemorrhage (ICH) and atrial fibrillation (AF) is a clinical dilemma. The aim of this study was to evaluate the management of anticoagulation therapy in patients with AF and admitted with ICH.

Methods: We performed a descriptive analysis of patients
admitted for ICH from 2009 to 2021. Data collection was carried out by consulting the processes and analyzing demographic, clinical and imaging data, and prior and post-discharge therapy. A comparative analysis of outcomes of anticoagulant therapy was performed between direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs).

Results: A total of 28 patients (22 male patients; median
age 75 years) were included in the study, of which 19 were
previously on anticoagulation therapy. Only eight (re)started anticoagulation after discharge. There were 19 deaths, of which 17 were in the group without post-discharge anticoagulation; of those, five occurred in the first month after ICH.

Conclusion: Most patients did not (re)initiate anticoagulation after ICH, despite being a high-risk group for new cerebrovascular events, which makes the discussion on this topic even more relevant. There was a change in the prescription pattern from VKAs to DOACs, comparing the two periods analyzed.