Sebina Bulic, MD

Åsberg S, Eriksson M, Henriksson KM, and Terént A. Warfarin-Associated Intracerebral Hemorrhage After Ischemic Stroke. Stroke. 2014

Warfarin continues to be major player for anticoagulation. NOAC became equally acceptable alternative. In safety analyzes of subgroups of patients with previous stroke, the annual rate of ICH in patients allocated warfarin was 0.8%, 1.0% and 0.5% for dabigatran, apixaban, and rivaroxaban trials respectively. In this register-based observational study, comprised of patients with first-ever ischemic stroke, who were discharged on warfarin, results were somewhat different.

Data from the two Swedish national registers linked through the patient’s unique personal identification numbers were used; The Swedish Stroke Register and Cause of Death Register. Data were analyzed for 2 periods; period 1 from January 2001 to December 2004, and period 2 from January 2005 to December 2008. Mean time of follow-up was 2.6 years, with a minimum follow-up time of 1 year.During the two 4-year periods, all ischemic stroke survivors discharged on warfarin (n=12,790) were included in the study. The proportion of patients with AF increased from 63.9% (n=3857) in the first period to 72.1% (n=4870) in the second period. During 31,800 person-years, there were 1237 recurrent strokes, of which 127 were ICH. Annual rates of ICH ranged from 0.37% in the first period to 0.39% in the second period, showing that incidence of ICH did not significantly change despite increased use of warfarin. Reasons for discrepancy of ICH incidence between this register-based observational study and subgroup analysis of the randomized prospective trials was not offered, but these results are certainly reassuring.