The impact of anticoagulant therapy on patients with hemorrhagic stroke: a retrospective observational study from eICU database
Year: 2023
Type: article
Study design: Observational Study
Abstract: The timing and effectiveness of anticoagulant therapy (AT) are controversial in patients with hemorrhagic stroke (HS). We aim to evaluate the potential impact of AT on in-hospital mortality in HS, and how this impact is influenced by the Acute Physiological and Chronic Health Evaluation (APACHE) IV score. We identified individuals with hemorrhagic stroke as the primary diagnosis (n=1654) using individual patient data from a national multicenter cohort study (eICU database; n=200859). With in-hospital mortality as the primary outcome, hemorrhagic stroke patients were split into the anticoagulant therapy group and the other treatment (OT) group. First, univariate and multivariate logistic regression analyses were conducted to identify independent predictors of in-hospital mortality in patients receiving different forms of treatment. Next, the independent predictor's interaction with the AT status was evaluated.Resultly, 8.3%(n=137) of patients were in AT group. The survival rate in the AT group was significantly higher than that in the OT group (87.6% vs. 78.8%; P < 0.05). AT was an independent predictor of in-hospital mortality risk in the entire cohort [OR= 0.542, 95%CI(0.298-0.985), P<0.05], and APACHE IV score [OR= 1.055, 95%CI(1.048-1.061), P<0.05] score was an independent predictor of in-hospital mortality in the OT group in multivariate logistic regression (P< 0.05). The APACHE IV score was used to predict the risk for the entire cohort (the area under the receiver operator characteristic curve was 0.825 [(95% CI (0.799-0.851)]. Patients who started anticoagulant therapy seemed to benefit more when the predicted in-hospital mortality risk was more than 6.9%, and patients without anticoagulant therapy seemed to benefit more when the predicted in-hospital mortality risk was less than 6.9%. In conclusion, patients diagnosed with hemorrhagic stroke benefit from AT. APACHE IV score has a better ability to predict in-hospital mortality risk. Specifically, the higher the predicted risk of in-hospital mortality, the greater the benefits of anticoagulant therapy.
Source: MEDS Clinical Medicine
Authors: Jun Chen, Ruoxue Bai, Nan Cheng, Xu Zhang, Xiaoxia Xie, Lan Li
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4387946277