Intracranial haemorrhage risk of warfarin unrelated to INR control

Study results show that choosing apixaban over warfarin could reduce the risk of anticoagulation-related intracranial haemorrhage.

MRI scan showing intracranial haemorrhage

Intracranial haemorrhage (ICH) is a devastating complication of anticoagulation therapy in patients with atrial fibrillation. Recent data show that apixaban, a non-vitamin K antagonist oral anticoagulant, carries a lower risk of ICH than warfarin.

To explore the factors associated with ICH, researchers analysed data from the ARISTOTLE trial involving 18,140 patients randomly assigned to apixaban or warfarin.

They found that ICH occurred at a rate of 0.80% per year in warfarin-treated patients and was not related to international normalised ratio (INR) control; 80% of warfarin-treated patients were within or below therapeutic range prior to ICH. The rate of ICH was 0.33% per year in apixaban-treated patients. The results also showed that aspirin use was independently associated with ICH risk.

Reporting in Blood (online, 29 March 2017)[1]
, the team says that the results indicate anticoagulation-related ICH could be reduced through preference for apixaban over warfarin and avoiding concomitant aspirin use, especially in older patients.


[1] Lopes RD, Guimarães PO, Kolls BJ et al. Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy. Blood 2017. doi: 10.1182/blood-2016-08-731638

Last updated
Clinical Pharmacist, CP, May 2017, Vol 9, No 5;9(5):DOI:10.1211/PJ.2017.20202608