Importance Although non–vitamin K antagonist oral anticoagulants (NOACs) are increasingly used to prevent thromboembolic disease, there are limited data on NOAC-related intracerebral hemorrhage (ICH). Objective To assess the association between preceding oral anticoagulant use (warfarin, NOACs, and no oral anticoagulants [OACs]) and in-hospital mortality among patients with ICH. Design, Setting, and Participants Retrospective cohort study of 141 311 patients with ICH admitted from October 2013 to December 2016 to 1662 Get With The Guidelines–Stroke hospitals. Exposures Anticoagulation therapy before ICH, defined as any use of OACs within 7 days prior to hospital arrival. Main Outcomes and Measures In-hospital mortality. Results Among 141 311 patients with ICH (mean [SD] age, 68.3 [15.3] years; 48.1% women), 15 036 (10.6%) were taking warfarin and 4918 (3.5%) were taking NOACs preceding ICH, and 39 585 (28.0%) and 5783 (4.1%) were taking concomitant single and dual antiplatelet agents, respectively. Patients with prior use of warfarin or NOACs were older and had higher prevalence of atrial fibrillation and prior stroke. Acute ICH stroke severity (measured by the National Institutes of Health Stroke Scale) was not significantly different across the 3 groups (median, 9 [interquartile range, 2-21] for warfarin, 8 [2-20] for NOACs, and 8 [2-19] for no OACs). The unadjusted in-hospital mortality rates were 32.6% for warfarin, 26.5% for NOACs, and 22.5% for no OACs. Compared with patients without prior use of OACs, the risk of in-hospital mortality was higher among patients with prior use of warfarin (adjusted risk difference [ARD], 9.0% [97.5% CI, 7.9% to 10.1%]; adjusted odds ratio [AOR], 1.62 [97.5% CI, 1.53 to 1.71]) and higher among patients with prior use of NOACs (ARD, 3.3% [97.5% CI, 1.7% to 4.8%]; AOR, 1.21 [97.5% CI, 1.11-1.32]). Compared with patients with prior use of warfarin, patients with prior use of NOACs had a lower risk of in-hospital mortality (ARD, −5.7% [97.5% CI, −7.3% to −4.2%]; AOR, 0.75 [97.5% CI, 0.69 to 0.81]). The difference in mortality between NOAC-treated patients and warfarin-treated patients was numerically greater among patients with prior use of dual antiplatelet agents (32.7% vs 47.1%; ARD, −15.0% [95.5% CI, −26.3% to −3.8%]; AOR, 0.50 [97.5% CI, 0.29 to 0.86]) than among those taking these agents without prior antiplatelet therapy (26.4% vs 31.7%; ARD, −5.0% [97.5% CI, −6.8% to −3.2%]; AOR, 0.77 [97.5% CI, 0.70 to 0.85]), although the interaction P value (.07) was not statistically significant. Conclusions and Relevance Among patients with ICH, prior use of NOACs or warfarin was associated with higher in-hospital mortality compared with no OACs. Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital mortality.

中文翻译：

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服用非维生素 K 拮抗剂与维生素 K 拮抗剂口服抗凝剂的患者脑出血与住院死亡率的相关性

重要性 尽管非维生素 K 拮抗剂口服抗凝剂 (NOAC) 越来越多地用于预防血栓栓塞性疾病，但关于 NOAC 相关脑出血 (ICH) 的数据有限。目的 评估先前使用口服抗凝剂（华法林、NOAC 和未口服抗凝剂 [OAC]）与 ICH 患者住院死亡率之间的关联。设计、设置和参与者 对 2013 年 10 月至 2016 年 12 月入院的 141 311 名 ICH 患者进行回顾性队列研究，其中 1662 名符合指南——卒中医院。暴露 ICH 前的抗凝治疗，定义为在到达医院前 7 天内使用任何 OAC。主要结果和措施 院内死亡率。结果 在 141 311 名 ICH 患者（平均 [SD] 年龄，68.3 [15.3] 岁；48.1% 女性）中，15 036 (10. 6%) 在 ICH 前服用华法林，4918 (3.5%) 在服用 NOACs，分别有 39585 (28.0%) 和 5783 (4.1%) 在同时服用单药和双联抗血小板药。既往使用华法林或 NOAC 的患者年龄较大，房颤和卒中发生率较高。急性 ICH 卒中严重程度（由美国国立卫生研究院卒中量表测量）在 3 组之间没有显着差异（华法林的中位数为 9 [四分位距，2-21]，NOAC 为 8 [2-20]，NOAC 为 8 [ 2-19] 没有 OAC）。华法林未调整的院内死亡率为 32.6%，NOAC 为 26.5%，无 OAC 为 22.5%。与既往未使用 OAC 的患者相比，既往使用华法林的患者院内死亡风险更高（调整风险差 [ARD]，9.0% [97.5% CI，7.9% 至 10.1%]；调整后的优势比 [AOR] 为 1.62 [97.5% CI，1.53 至 1.71]），并且在先前使用过 NOAC 的患者中更高（ARD，3.3% [97.5% CI，1.7% 至 4.8%]；AOR，1.21 [97.5%] CI，1.11-1.32]）。与既往使用华法林的患者相比，既往使用 NOAC 的患者院内死亡风险较低（ARD，-5.7% [97.5% CI，-7.3% 至 -4.2%]；AOR，0.75 [97.5%] CI，0.69 至 0.81]）。在既往使用过双重抗血小板药物的患者中，NOAC 治疗患者和华法林治疗患者之间的死亡率差异在数值上更大（32.7% 对 47.1%；ARD，-15.0% [95.5% CI，-26.3% 至-3.8%） ]; AOR, 0.50 [97.5% CI, 0.29 to 0.86]) 比服用这些药物而未接受抗血小板治疗的患者（26.4% vs 31.7%; ARD, -5.0% [97.5% CI, -6.8% to -3.2%]） ；AOR，0.77 [97.5% CI，0.70 至 0.85]），尽管交互作用 P 值（. 07) 没有统计学意义。结论和相关性 在 ICH 患者中，与未使用 OAC 相比，先前使用 NOAC 或华法林与更高的院内死亡率相关。与先前使用华法林相比，先前使用 NOAC 与较低的院内死亡率风险相关。