Background: Since the emerging new-oral anticoagulants (NOAC), the patients and physicians’ preference for administering NOAC in patients with non-valvular atrial fibrillation is increasing rapidly. However, NOAC-related hemorrhagic events, particularly intracerebral hemorrhage (ICH) should not be ignored. The present study aimed to investigate the secular trends of NOAC-related ICH from a single center stroke registry.
Methods: This study obtained data related to consecutive acute ICH patients from National Taiwan University Hospital Stroke Registry during January 2006 to December 2017. Using the SMASH-U method, patients were classified into 6 subtypes: structural vascular lesions, medication-related, cerebral amyloid angiopathy (CAA), systemic disease-related, hypertensive angiopathy (HA), or undetermined. Furthermore, patients who had ICH associated with oral anticoagulants, warfarin or NOAC, were recorded. The secular trend was evaluated in biennial base.
Results: During a 12-year period, there were 2919 spontaneous ICH patients (male, 62.8%; mean age, 61.1+16.7 years) with 3046 episodes. including HA (51.8%), CAA (14.7%), systemic disease (11.2%), undetermined (9.4%), structural vascular lesions (7.0%), and medication-related (6.0%). The frequencies of oral anticoagulant-related ICH increased from 4.2% in 2006-07, to 6.3% in 2010-11, and then decreased to 3.8% in 2014-15, and 4.8% in 2016-17. However, NOAC-related ICH increased gradually, from none before 2013, to 1.3% in 2014-15, and 1.7% in 2016-17 (P for trend=0.028). There was significant higher 3-month mortality in warfarin-related ICH than NOAC-related ICH (P=0.043).
Conclusion: Although warfarin-related ICH decreased gradually, NOAC-related ICH has increased in the opposite way. NOAC-related ICH should not be overlook in the future.

Secular Trend of Anticoagulant-Related Intracerebral Hemorrhage