Changes in the use of vitamin K antagonists and direct oral anticoagulants and impact on the incidence of oral anticoagulation-related intracerebral hemorrhage: population-wide prescription patterns in two 5-year cohorts

BACKGROUND: We investigated population-wide changes in prescriptions of oral anticoagulants (OAC) (vitamin K antagonists [VKA]) compared to direct oral anticoagulants (DOAC) and whether these translated into a decline in incidences of OAC-related intracerebral hemorrhages (ICH). METHODS: This observational study analyzed OAC use in Southern Finland during 2005-2009 (pre-DOAC era) and 2015-2019 (transition-to-DOAC era) based on national registries. From medical records, we identified all non-traumatic ICH patients admitted to our tertiary hospital, the only one admitting neurological emergencies within the region. We compared the impact of DOACs versus VKAs on annual ICH incidence using an adjusted generalized additive model (GAM). RESULTS: < 0.001). CONCLUSIONS: ICH incidence remained stable despite near-doubled OAC use. The lower ICH rates with DOACs compared to VKAs support their safety advantage.