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Oral Anticoagulation and Mortality in Cases with Intracranial Bleeding: Analysis of Nationwide Prescription and
Knut Kröger1, Fabian Heldt1, Ludger Feyen2
1Clinic of Vascular Medicine, HELIOS Klinik Krefeld, Germany.
Insights
Direct oral anticoagulants (DOACs) are safe for elderly patients, as their use in intracranial bleeding (ICB) cases increased slower than in general hospitalizations. Mortality rates for ICB patients on DOACs also decreased, indicating improved outcomes.
Area of Science:
- Geriatric Medicine
- Neurology
- Pharmacology
Background:
- Direct oral anticoagulants (DOACs) are increasingly prescribed for various conditions.
- Intracranial bleeding (ICB) is a serious complication associated with anticoagulant use.
- Assessing the safety of DOACs in elderly populations, particularly concerning ICB, is crucial.
Purpose of the Study:
- To evaluate the safety of DOACs in patients aged 60 years and older.
- To compare the incidence of ICB hospitalizations among patients on long-term anticoagulation (LUA) versus the general hospitalized population.
- To analyze intrahospital mortality rates in ICB cases with and without LUA.
Main Methods:
- Retrospective analysis of nationwide German hospitalization data from 2006 to 2020.
- Inclusion of all hospital admissions and specific admissions for ICB in patients aged ≥60 years.
- Stratification of data based on long-term use of anticoagulants (LUA).
Main Results:
- The age-standardized rate of hospitalized patients with LUA significantly increased from 2006 to 2020 for both males and females.
- The proportion of ICB hospitalizations among patients with LUA also rose during the study period.
- Mortality rates in ICB cases with LUA showed a decreasing trend, outperforming those without LUA.
Conclusions:
- Long-term use of anticoagulants (LUA) appears safe in elderly patients, evidenced by a slower rise in LUA rates among ICB cases compared to general hospitalizations.
- Mortality in ICB patients on LUA demonstrated a tendency towards decrease relative to non-LUA cases.
- The findings suggest that DOACs can be safely managed in elderly individuals, even in the context of ICB.
Objectives:
To demonstrate the safety of direct oral anticoagulants in relation to intracranial bleeding (ICB), we compared the number of patients taking anticoagulants in all cases of hospitalization and cases of hospitalization for ICB over time in Germany. We analyzed the intrahospital mortality of ICB cases in relation to long-term use of anticoagulants (LUAs).We performed a retrospective registry analysis of nationwide German hospitalizations including all hospital admissions and admission for ICB in patients aged ≥60 years in the period from 2006 to 2020 and separated for LUAs.
Results:
In 2006, the age-standardized rate of hospitalized male patients with LUAs was 7.3% and that of female patients was 5.6%. In 2020, the rates increased to 22.0 and 17.7% for male and female patients, respectively. Among patients hospitalized for ICB in 2006, 7.0 and 5.6% were male and female patients with LUAs, respectively. In 2020, the rate increased to 13.7% for males and 10.8% for females.In 2006, age-standardized mortality rates of male and female patients with ICB without LUAs were 24.1 and 23.9%, respectively. In 2020, the rate slightly decreased to 22.7% in males, but it remained almost unchanged in females at 23.8%. In the cases with LUA, the mortality rate decreased from 30.1 to 24.3% in males and from 28.4 to 24.2% in females in the same period.
Conclusion:
LUA seems to be safe because there is a slower increase of the rate of LUAs in ICB cases than in generally hospitalized cases in the period from 2006 to 2020. In addition, mortality in ICB cases with LUA tends to decrease compared to cases without LUA.
