Abstract 145: Anticoagulation-Related Intracerebral Hemorrhage and Time to Reversal Treatment After Intracerebral Hemorrhage in the United States
Bibliographic record
Abstract
Background: Anticoagulation-associated intracerebral hemorrhage (AC-ICH) often results in death. Specific reversal agents are available, but it is not clear whether there is a time-dependent treatment effect. We characterized patients with AC-ICH and investigated the relationship between time to treatment and outcome. Methods: We analyzed data from 9492 AC-ICH patients who presented within 24 hours of onset across 465 hospitals reporting any anticoagulation reversal treatment in GWTG-Stroke from 2015 to 2021. For patients with available door-to-treatment (DTT) times, outcomes were analyzed using logistic regression models adjusted for demographic, history, baseline, and hospital characteristics. A spline plot for mortality was generated for DTT and in-patient mortality from the adjusted predicted outcome probability. Results: Among 9492 patients admitted within 24h of AC-ICH, the median age was 77 years, 45% female, and NIHSS median 11. 79% (7469) received reversal treatment and 21% (2143) did not. Among reversal patients, pretreatment AC was warfarin in 62.2% and a direct oral anticoagulant in 37.8%. For 5224 patients with documented times, median onset to treatment time was 232 (IQR 142-185) minutes and DTT was 82 (58-117) mins, with DTT ≤60m for 27.7%. DTT ≤60 minutes was associated with lower odds of mortality than a DTT of >61-180 minutes (aOR 0.83 [95% CI: 0.69-1.00]). Factors associated with DTT ≤ 60 minutes include white non-Hispanic race, higher blood pressure, lower NIHSS, and a larger hospital size. Spline plotting showed a steep mortality increase with longer DTT in the first 30-minutes post-arrival (Figure). Conclusion: In US hospitals participating in GWTG-Stroke reporting reversal therapy, most patients with AC-ICH received reversal agents. Earlier administration was associated with improved survival. These findings support intensive efforts to accelerate evaluation and treatment for patients with this devastating form of stroke.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".