Optimal timing of anticoagulation therapy for venous thromboembolism prevention after intracranial hemorrhage.

Abstract

OBJECTIVE: This study aimed to explore the optimal timing of anticoagulation initiation for the prevention of VTE in patients with ICH. METHODS: This retrospective cohort study enrolled consecutive patients in Nanjing Drum Tower Hospital and The Medical Information Mart for Intensive Care IV database in the United States who were diagnosed with ICH. The restricted cubic spline was fitted to explore the dose-response relationship between anticoagulation initiation time and clinical outcomes. Based on the identified inflection point, patients were stratified into the ≤ 2 days group and the >2 days group according to the timing of anticoagulant initiation. The primary outcome was a composite outcome of VTE and intracranial rebleeding events. RESULTS: A total of 3,841 patients were divided into ≤ 2 days group (n = 2047) and >2 days group (n = 1794). HRs for ≤ 2 days group and >2 days group of composite outcome, VTE and intracranial rebleeding events were 1.20 (1.02–1.43), 2.01 (1.59–2.55) and 0.68 (0.53–0.87). For the subgroup analysis, significant interactions were observed between gender, race, etiology, location of ICH, and treatment group for the composite outcome (P<0.05). Compared to the all other races, a difference was observed in the relationship between anticoagulation initiation time and outcome events in Asians. CONCLUSIONS: Initiating anticoagulation within 2 days of ICH can balance bleeding and thrombosis risks, and should be administered to patients of all races to optimize outcomes.