Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Intracerebral hemorrhage (ICH) survivors on oral anticoagulation face a dilemma regarding treatment resumption.
• Previous research focused on recurrent stroke, neglecting functional recovery and cardioembolic risk.
• This study examines the interplay between cardioembolic stroke risk, anticoagulation resumption, and functional outcomes post-ICH.

Purpose of the Study:

• To investigate the association between cardioembolic stroke risk (CHA2DS2-VASc score) and functional recovery after ICH.
• To determine the impact of oral anticoagulation therapy resumption on functional recovery in ICH survivors.
• To explore the interaction between cardioembolic stroke risk and anticoagulation resumption on recovery.

Main Methods:

• Joint analysis of three observational studies (RETRACE, MGH ICH, ERICH) including 941 ICH survivors.
• Participants were on anticoagulation for nonvalvular atrial fibrillation and had no recurrent stroke or ICH at 1 year.
• Multivariable models assessed the association of CHA2DS2-VASc scores and anticoagulation resumption with functional recovery (modified Rankin Scale ≤3 at 1 year).

Main Results:

• Higher CHA2DS2-VASc scores were associated with a decreased likelihood of functional recovery (OR, 0.83 per point increase).
• Anticoagulation resumption was independently linked to a higher likelihood of functional recovery (OR, 1.89).
• A significant interaction (P=0.011) showed that anticoagulation resumption weakened the negative association between CHA2DS2-VASc score and recovery.

Conclusions:

• Increased cardioembolic stroke risk correlates with poorer functional recovery 1 year post-ICH.
• Resuming oral anticoagulation therapy enhances functional recovery, mitigating the impact of high stroke risk.
• Findings support incorporating recovery metrics into future studies on anticoagulation resumption after ICH.