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B.4 Time to intervention in anticoagulant-associated intracerebral hemorrhage: gaps in care and their effect on hematoma expansion

Published online by Cambridge University Press:  10 July 2025

C Brassard
Affiliation:
(Montreal)*
C Dumouchel
Affiliation:
(Montreal)*
AI Constantinu
Affiliation:
(Montreal)
GN Mendes
Affiliation:
(Montreal)
L Panetta
Affiliation:
(Montreal)
N Au
Affiliation:
(Toronto)
E Babak
Affiliation:
(Toronto)
L Letourneau-Guillon
Affiliation:
(Montreal)
LC Gioia
Affiliation:
(Montreal)
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Abstract

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Background: In intracerebral hemorrhage (ICH), hematoma expansion (HE) is a major predictor of mortality and morbidity. A rapid approach, including oral anticoagulant (OAC) reversal and blood pressure (BP) reduction, both <60 min from arrival, improves outcomes. We aimed to evaluate current time metrics in the management of anticoagulant-associated intracerebral hemorrhage (AAICH) and their impact on HE in a high-income setting. Methods: Consecutive AAICH patients presenting to a high-volume stroke center (2017-2023) were retrospectively identified. Clinical and imaging data were merged, with baseline and follow-up hematoma volumes quantified using 3D Slicer segmentation software. Results: Of 75 AAICH patients, 62 received antihypertensives and 52 OAC reversal, with median(IQR) times to BP control: 87.5 (61-207) minutes and median time to OAC reversal: 67.5 (49-96) minutes. Only 14 (23%) and 23 (44%) achieved treatment targets <60 minutes, respectively, and 7 (9%) patients achieving both targets. HE occurred in 27 of 48 patients with follow-up imaging. Median time to target BP was significantly longer in those with HE (186.5 (87-317) min) compared to those without HE (70 (56-104) min), p=0.01. Conclusions: Current management of AAICH remains heterogeneous, with considerable treatment delays regarding BP control and OAC reversal. These findings support the implementation of standardized protocols to optimize AAICH treatment.

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Abstracts
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation