In prior randomized trials, the incidence of intracerebral hemorrhage (ICH) was significantly lower with the new oral anticoagulants (NOACs) than with warfarin (Blood 2014; 124:1968). However, it remains unclear if clinical outcomes are similar when ICH does occur with different anticoagulants? To address this question, U.K. researchers performed a retrospective study that compared 52 patients who suffered ICHs while taking warfarin with 11 patients who suffered ICHs while taking NOACs (6 on rivaroxaban, 3 on dabigatran, and 2 on apixaban). Patients with major head trauma or known structural reasons for ICH were excluded. Mean international normalized ratio (INR) was 2.5 in warfarin-treated patients.
The average ICH volume was 3.5-fold larger with warfarin than with NOACs (8.9 vs. 2.4 mL). These larger ICHs in warfarin patients translated to worse functional outcomes at hospital discharge compared with NOAC patients.