Intracerebral Hemorrhage Outcomes after Reversal of Subtherapeutic Warfarin: Analysis of Data from GWTG-Stroke
Bibliographic record
Abstract
Abstract Background Current guidelines recommend reversal of warfarin anticoagulation with intracranial hemorrhages. The benefit of reversing subtherapeutic warfarin anticoagulation in acute spontaneous intracerebral hemorrhage (ICH) is uncertain. Methods An observational cohort used Get With The Guidelines® Stroke registry between January 2015 and January 2022 to determine association of reversal with outcomes for subtherapeutic anticoagulation (INR 1.5 to 1.9). Exclusions were thrombolytics, direct oral anticoagulants, transferring out, or leaving against medical advice. Results The primary outcome (mRS 0-3 at discharge) was assessed among 1868 patients (mean age 73 years, 42% female), which occurred in 188/894 (21.0%) with reversal and 225/974 (23.1%) without reversal (adjusted odds ratio (aOR) 0.80 [95% CI 0.63-1.005]). Ordinal analysis showed higher odds of mRS 0-4 vs. 5-6 with reversal {52.7% vs 42.5% (aOR 1.21 [1.001, 1.48])}. Outcomes not requiring mRS were analyzed among 2569 patients. Mortality or discharge to hospice was lower with reversal {30.6% vs 41.5% (aOR 0.75 [95% CI, 0.63, 0.89])}. Fewer were ambulatory at discharge {25.8% vs 35.7% (aOR 0.68 [0.54, 0.85])}, fewer discharged to home {18.4% vs 21.7% (aOR 0.79 [0.65, 0.97])}, more discharged to skilled nursing {21.0% vs 15.7% (aOR 1.33 [1.08, 1.65])}, and more discharged to rehabilitation {24.9% vs 18.9% (aOR 1.20 [0.98, 1.47])}. Hospital length of stay was longer {median 6 vs 4 days (adjusted risk ratio (aRR) 1.25 [95% CI, 1.13, 1.37]). There was no difference in venous thromboembolism {2.9% vs 2.3% (aOR 1.47 [0.88, 2.46])}. Discussion Reversal of subtherapeutic warfarin with acute spontaneous intracerebral hemorrhage and INR 1.5 - 1.9 was not associated with improvement in functional outcome based upon discharge mRS 0-3 vs 4-6. Patients that received a reversal agent had 25% lower odds of dying in the hospital or being discharged to hospice, but had a longer hospital stay and were less likely to be fully ambulatory at discharge.
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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 | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".