Study identifies risk factors for ICH in AF patients on NOACs

Among atrial fibrillation (AF) patients treated with nonvitamin K antagonist oral anticoagulants (NOACs) for stroke prevention, several parameters predict intracerebral haemorrhage (ICH), including older age, concurrent use of antiplatelet drugs, and hyperlipidaemia, among others, but not HAS-BLED and CHA₂DS₂-VASc scores, a study has found.

The analysis included 419 consecutive AF patients (mean age, 78.8±8.1 years) who developed ICH during NOAC treatment, as well as 1,526 controls who did not have ICH. Given a number of common risk factors within the CHA₂DS₂-VASc and HAS-BLED scores, several multivariable logistic regression models were applied to identify independent prespecified predictors for ICH events.

Results revealed multiple risk factors for ICH. These included increasing age, concomitant use of antiplatelet drugs, active malignancy, elevated risk of fall, hyperlipidaemia, low creatinine clearance, peripheral artery disease, and white matter alterations.

Low doses of NOACs (whether or not given according to label) and congestive heart failure, on the other hand, were inversely correlated with the risk of ICH.

Meanwhile, HAS-BLED and CHA₂DS₂-VASc scores performed poorly in predicting ICH, with areas under the curves of 0.496 (95 percent confidence interval [CI], 0.468–0.525) and 0.530 (95 percent CI, 0.500–0.560), respectively.

Clinical trials on stroke prevention in AF patients have consistently shown clinical benefit from either warfarin or NOACs. NOAC-treated patients have been reported to be at lower risk of ICH than warfarin-treated patients.