(134) Antithrombotic Therapy in Atrial Fibrillation Patients with Intracranial Hemorrhage: Retrospective Cohort Study with Administrative Data in Japan

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 808

Presenting Author(s)

Shinobu Imai, PhD
– Associate professor, Hachioji-Shi, Tokyo, Japan

Co-Author(s)

Masato Koizumi
– Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
Chi-Chuan Wang
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, Zhong Zheng Qu, Taipei, Taiwan (Republic of China)
Euna Han
– Health Economics & Pharmaceutical Health Services Research, College of Pharmacy, Yonsei University, Republic of Korea
Manabu Akazawa
– Meiji Pharmaceutical University, Japan

Background: Atrial Fibrillation (AF) is one of the common diseases among cardiac arrhythmias. Oral anticoagulants (OACs) including direct thrombin inhibitor (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban), and vitamin K antagonist (warfarin) are the essential treatments for the management of patients with nonvalvular atrial fibrillation to prevent stroke and reduce all-cause mortality.

Objectives: The present study aimed to describe the treatment profile of antithrombotic therapy after intracranial hemorrhage in patients with atrial fibrillation.

Methods: We conducted a retrospective observational study using hospital-based claims data. We extracted patients who were hospitalized by ICH with AF as comorbidity from a database managed by the National Hospital Organization between October 2011 and September 2020. We defined the ICH admission if patients had ICH diagnoses code (I60-61) at admission. We also defined the AF comorbidity if patients had AF diagnoses code (I48) as comorbidities on the day or within 6 months of the admission. To discuss the differences of profile between the OACs users versus non-users, age, sex, length of stay CHA2DS2 -VASc score Charlson comorbidity score, concomitant medications were compared. We defined the OACs user if patients were prescribed the relevant medications during hospitalization.

Results: During the study periods, 1,724 patients were selected for the analysis. There were 893 patients in the non-user group and 831 patients in the OACs group at discharge. The OACs users had more proportion of patients aged 75 years and older (552 [66.4%] vs. 567 [63.5%]), had longer hospital stay (29.0 days vs. 23.0 days), and had higher CHA2DS2-VASc score of 4 or higher in severe cases (316 [38.0%] vs. 283 [31.7%]) than non-users. In terms of comorbidities, the OACs group had more cerebrovascular disease (215 [25.9%] vs. 183 [20.5%]), heart failure (174 [20.9%] vs. 147 [16.5%]), and kidney disease (16 [1.9%] vs. 37 [4.1%]) than the non-OACs group. There were more cases of concomitant use of calcium channel blockers in the OACs group than in the non-OACs group (694 [83.5%] vs. 601 [67.3%]).

Conclusions: In this study, the patients who received OACs therapy were more severely ill than those who did not receive OACs, confirming that OACs are appropriately selected for high-risk cases in clinical practice.