Clinical characteristics and outcomes of intracranial hemorrhage in geriatric patients receiving non-vitamin K antagonist oral anticoagulants: a multicenter observational study

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Guven R., Avci A., Sogut O., Dogan S., KARAMERCAN M. A., Altinbilek E., ...Daha Fazla

IRISH JOURNAL OF MEDICAL SCIENCE, 2026 (SCI-Expanded, Scopus)

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Background Evidence comparing different non-vitamin K antagonist oral anticoagulants (NOACs) in terms of intracranial hemorrhage (ICH) characteristics and clinical outcomes is limited. Aim This study aimed to identify factors associated with mortality and morbidity in geriatric patients receiving different NOACs presenting to the emergency department with intracranial hemorrhage. Methods This multicenter retrospective observational study. Geriatric patients (aged >= 65 years) who presented to the emergency department with ICH while receiving NOAC therapy were included. Clinical characteristics were extracted from electronic medical records. The primary outcome was in-hospital mortality, while secondary outcomes included hemorrhage volume, intraventricular hemorrhage, intensive care unit admission, and the effect of four-factor prothrombin complex concentrate administration. Statistical analyses were performed using the chi-square or Fisher's exact tests for categorical variables and the Mann-Whitney U or t-test for continuous variables, with p < 0.05 considered statistically significant. Results A total of 47 patients were included; 57.4% (n = 27) were female and 42.6% (n = 20) were male. No significant association was observed between NOAC type and in-hospital mortality (p = 0.533). Intraventricular hemorrhage was significantly more frequent in the rivaroxaban group than in the apixaban group (42.9% vs. 9.5%, p = 0.014). Intraventricular hemorrhage (52.6% vs. 4.2%, p < 0.001) and atrial fibrillation (90.5% vs. 57.7%, p = 0.012) were significantly more common in the mortality group compared with the survival group. Conclusion NOAC type was not associated with in-hospital mortality; however, intraventricular hemorrhage occurred more frequently in patients receiving rivaroxaban and was significantly associated with mortality.