(578) Assessing Optimal Time to Anticoagulation Reversal in Intracerebral Hemorrhage

Introduction: Patients on home anticoagulation who are diagnosed with intracerebral hemorrhage (ICH) have a higher risk of morbidity and mortality. Current guidelines do not define optimal time to anticoagulation reversal in ICH patients. Recent studies have associated faster administration of anticoagulation reversal with reduced incidence of hematoma expansion and improvement in mortality. This study evaluated the association between faster time to administration of anticoagulation reversal and change in Modified Rankin Scale (mRS) in ICH patients.

Methods: This retrospective, observational cohort study included adult patients on home anticoagulation diagnosed with an isolated intracerebral hemorrhage who received anticoagulation reversal at Northeast Georgia Medical Center between January 1, 2018 – September 30, 2022. The primary outcome was incidence of mRS change for patients who received a reversal agent within 90 minutes (expedited reversal) compared to those receiving reversal after 90 minutes (standard reversal). Change in mRS was defined as documented change from mRS 0 – 2 to mRS 3 – 6. Secondary outcomes included mRS change when anticoagulation reversal was given within 30 and 60 minutes and incidence of thrombotic events or hematoma expansion after reversal agent administered.

Results: Sixty-one patients met inclusion criteria, 36 patients received expedited reversal and 25 received standard reversal. Baseline characteristics were similar between groups. There was no difference between groups in mRS change for patients who received expedited anticoagulation reversal (75% vs. 52%, p=0.07); reversal within 60 minutes (71% vs. 63%, p=0.49) or reversal within 30 minutes of arrival (100% vs. 64%, p=0.3) compared to after these time points. There was a similar incidence in hematoma expansion (3% vs. 4%) and thrombotic events (6% vs. 0%).

Conclusions: Change in mRS was similar for ICH patients who received expedited anticoagulation reversal compared to those receiving standard reversal. As safety outcomes were comparable between groups, expedited reversal should be considered for all ICH patients on home anticoagulation. Additional research is needed to better identify the optimal time window for anticoagulation reversal for ICH patients.