Intracerebral Hemorrhage Outcomes After Reversal of Subtherapeutic Warfarin: Analysis of Data From GWTG-Stroke
Bibliographic record
Abstract
BACKGROUND: Current guidelines recommend reversal of warfarin anticoagulation in intracranial hemorrhages. The benefit of reversing subtherapeutic warfarin anticoagulation in acute spontaneous intracerebral hemorrhage is uncertain. METHODS: An observational cohort from the entire Get With The Guidelines Stroke registry between January 2015 and January 2022 was used to determine the association of reversal with outcomes for subtherapeutic anticoagulation (international normalized ratio, 1.5-1.9). Inclusion required current warfarin use. Exclusions included thrombolytics, direct oral anticoagulants, transferring out, or leaving against medical advice. The prespecified primary outcome was the modified Rankin Scale (mRS) score of 0 to 3 at discharge. Logistic regression was used to assess the association between reversal and the mRS score of 0 to 3. Propensity scores with overlap weighting were used to control treatment selection bias. Information on the dose and timing of reversal agents was unknown. RESULTS: Initial cohort 239 681 patients, 18 419 on warfarin. Excluded were 15 712 with an international normalized ratio ≤1.5, ≥1.9, or missing, and 701 missing mRS. Final cohort 1868 (mean age 73, 42% female). Reversal occurred in 894 (47.9%). Primary outcome occurred in 188/894 (21.0%) versus 225/974 (23.1%) with reversal versus without (adjusted odds ratio, 0.80 [95% CI, 0.63-1.005]). Ordinal analysis showed higher odds of mRS score of 0 to 4 versus 5 to 6 (52.7% versus 42.5% [adjusted odds ratio, 1.21 [1.001-1.48]). Outcomes not requiring mRS were analyzed among 2569 patients. Mortality or discharge to hospice was lower 30.6% versus 41.5% (adjusted odds ratio, 0.75 [95% CI, 0.63-0.89]). Hospital length of stay was longer (median, 6 versus 4 days; adjusted risk ratio, 1.25 [95% CI, 1.13-1.37]). There was no difference in venous thromboembolism (2.9% versus 2.3%; adjusted odds ratio, 1.47 [0.88-2.46]). CONCLUSIONS: Reversal of subtherapeutic warfarin with acute spontaneous intracerebral hemorrhage and international normalized ratio 1.5 to 1.9 was not associated with improvement in functional outcome based on discharge mRS score of 0 to 3 versus 4 to 6. Patients receiving reversal agents had 25% lower odds of dying in hospital or being discharged to hospice, but had a longer hospital stay. This exploratory data has limitations inherent to not being a randomized controlled trial.
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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 | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 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".