Abstract DP283: Predictors of Delayed Coagulopathy Reversal in Patients with Intracerebral Hemorrhage: An Exploratory Analysis of a Statewide Stroke Registry

Background: Timely coagulopathy reversal treatment for primary ICH is essential to ensure optimal patient outcomes, yet delays remain common. Understanding patient and system factors associated with treatment delays is essential for improving patient outcomes. We set out to assess the impact of pre-hospital factors on coagulopathy reversal delays among patients with primary intracranial hemorrhage. Methods: We conducted a retrospective observational cohort study of patients with primary ICH and timed-stamped administration of anticoagulant reversal from 44 Michigan hospitals between 1/1/2023 and 12/31/2024. Data included linked pre-hospital (Mi-EMSIS) and hospital (GWTG-Stroke) data. Using multivariable modeling, we compared baseline demographic, geographic, pre-hospital, and hospital characteristics between timely and delayed reversal, defined as >1 hour from emergency department presentation to reversal administration. Results: The cohort included 297 patients, and 58 (19.5%) received anticoagulation reversal within 60 minutes of arrival. Patients arriving by private transportation had reduced odds of timely reversal compared to those arriving via EMS (OR: 0.292; 95% CI: 0.095-0.741). Black patients also had a lower odds of timely reversal treatment compared to White patients (OR: 0.297; 95% CI: 0.066-0.962). Geographic location, age, sex, systolic blood pressure, prior anticoagulant use, and hospital stroke certification were not significantly associated with timely reversal. Conclusion: Race and mode of arrival were significantly associated with delayed coagulopathy reversal in primary ICH. These findings highlight potential operational targets to improve time-sensitive stroke care.