Blood pressure management in the first 24 hours for intracerebral hemorrhage patients on oral anticoagulant therapy.

Abstract

Objective: To investigate the differences in blood pressure (BP) management and outcomes between intracerebral hemorrhage (ICH) patients on oral anticoagulant (OAC) therapy compared to those not on OAC therapy within the first 24 h of hospital admission.

Methods: This retrospective cohort study included 165 ICH patients admitted to a comprehensive stroke center between July 1, 2014 and June 30, 2021. Patients were divided into two groups: those on OAC therapy (n = 55) and those not on OAC therapy (n = 110). BP measurements, including systolic BP (SBP) within 24 h of post-admission, were recorded. Clinical outcomes, such as mortality, modified Rankin Scale (mRS) scores, and length of hospital stay, were assessed. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to evaluate the impact of BP management on patient outcomes.

Results: No significant differences in overall survival were observed between the OAC and non-OAC groups. Although the mean SBP at 24 h was slightly higher in the OAC group (142 mmHg) compared to the non-OAC group (136 mmHg; p = 0.032), this did not translate into differences in mortality or functional outcomes. Higher ICH scores were associated with increased mortality risk (HR 2.01, 95% CI 1.29-3.12, p = 0.002). Higher GCS scores were associated with better functional outcomes (HR 0.92, 95% CI 0.85-0.99, p = 0.035), while BP management strategies did not show a significant impact.

Conclusion: BP management in the first 24 h for ICH patients on OAC may not significantly affect mortality or functional outcomes. Current BP management strategies may be applicable to both OAC and non-OAC patients, though further research is needed to explore tailored approaches.