Abstract 4139732: Timing of Anticoagulation in Pulmonary Embolism with Nontraumatic Intracranial Hemorrhage: A Multi-National Database Study

Background: Pulmonary embolism (PE) occurs in 1% of patients with nontraumatic intracranial hemorrhage (ICH) despite thromboprophylaxis. Anticoagulation is the primary treatment of hemodynamically stable PE; however, risks of bleeding complications in ICH exist. We investigated the optimal timing of anticoagulation in patients with PE and ICH using a large retrospective database. Methods: We included patients with nontraumatic ICH and PE without acute cor pulmonale or prior long-term anticoagulation from the TriNetX Research Network. Patients were then categorized as early (0-3 days after ICH), intermediate (4-14 days), late (15-60 days), or no anticoagulation. Chi-square and independent t -tests were used for bivariable analyses. Cohorts were 1:1 propensity score-matched by 17 covariables including demographic information and comorbidities. Outcomes were all-cause mortality, neurological deficits due to ICH, and extracranial hemorrhage 90 days after ICH. Results: Of 13,042 included patients, mean age was 65±16 and 45% were female. Those receiving early anticoagulation after ICH had higher risk of mortality (RR=1.29, 95% CI: 1.20-1.38), neurological deficits, and extracranial hemorrhage compared to no anticoagulation. Intermediate anticoagulation had similar outcomes to no anticoagulation. Late anticoagulation had lower risk of mortality (RR=0.78, 95% CI: 0.66-0.92) and no significant difference in other outcomes. Conclusions: In patients with ICH and PE without acute cor pulmonale, early anticoagulation was associated with increased mortality, neurological deficits, and extracranial hemorrhage compared to no anticoagulation. Late anticoagulation was associated with decreased mortality and similar risks of neurological deficits and extracranial hemorrhage.