ABSTRACT NUMBER: ESOC2026A523 CLINICAL OUTCOMES FOLLOWING EARLY DIRECT ORAL ANTICOAGULANTS INITIATION IN LOBAR AND NON-LOBAR INTRACEREBRAL HEMORRHAGE WITH ATRIAL FIBRILLATION

Abstract Background and aims Lobar intracerebral hemorrhage (ICH) potentially carries a higher recurrence risk than non-lobar ICH; however, evidence in ICH survivors who (re)initiate antithrombotic therapy remains limited. This study aimed to investigate longitudinal clinical outcomes in patients with lobar versus non-lobar ICH (re)initiating antithrombotic therapy. Methods We performed a subgroup analysis of a multicenter, prospective, observational registry (UMIN000045210) including patients with acute intracranial hemorrhage who (re)initiated direct oral anticoagulants (DOAC) for atrial fibrillation. The primary outcome was the composite of symptomatic Intracranial hemorrhage, stroke, or any death within 12 months after DOAC (re)initiation. Secondary outcomes included each component individually. Results Of 254 enrolled cases, 168 ICH confirmed by an independent CT-based adjudication committee were included (38 lobar, 130 non-lobar). Compared with non-lobar ICH, patients with lobar ICH were older (median 81 vs. 79, y), had lower HAS-BLED (2 vs. 3) and CHA2DS2-VASc scores (3 vs. 4), larger hematoma volumes, (16.7 vs. 5.7, ml) and higher baseline NIHSS scores (13 vs. 7). The median time to DOAC (re)initiation was 8 days for lobar ICH and 7 days for non-lobar ICH. The primary outcome occurred in 11 patients (28.9%,95%CI 15.4-45.9) and 25 patients (19.2%,95%CI 12.8-27.1) with lobar and non-lobar ICH, respectively. Lobar ICH was associated with higher rates of symptomatic intracranial hemorrhage (10.5% vs. 3.8%), stroke (10.5% vs. 7.7%), and death (15.8% vs. 11.5%). Conclusions Lobar ICH was associated with numerically higher adverse event rates, without delays in DOAC (re)initiation compared with non-lobar ICH. Conflict of interest present