Incidence, mortality, and risk factors for oral anticoagulant-associated intracranial hemorrhage in patients with atrial fibrillation

Warfarin, a vitamin K epoxide reductase inhibitor, is the oral anticoagulant most commonly used to reduce the risk of stroke in patients with atrial fibrillation (AF). Warfarin has proved to be efficacious for this purpose in multiple clinical trials. However, warfarin use is laborious and associated with an increased risk of intracranial hemorrhage (ICH). Various factors increase the risk of warfarin-related ICH, including older age, intensity of anticoagulation, hypertension, and history of cerebrovascular disease. The emergence of newer classes of oral anticoagulants will offer therapeutic alternatives to reduce the risk of stroke in patients with AF. Recently, the United States Food and Drug Administration approved 3 new agents-dabigatran etexilate, a direct thrombin inhibitor, and rivaroxaban and apixaban, factor Xa inhibitors- to reduce the risk of stroke and systemic embolism in patients with nonvalvular AF. We discuss the incidence, mortality, and risk factors predisposing to oral anticoagulant-associated ICH in patients with AF.