ImportanceIntracerebral hemorrhage (ICH) is the deadliest stroke subtype, and mortality rates are especially high in anticoagulation-associated ICH. Recently, specific anticoagulation reversal strategies have been developed, but it is not clear whether there is a time-dependent treatment effect for door-to-treatment (DTT) times in clinical practice.ObjectiveTo evaluate whether DTT time is associated with outcome among patients with anticoagulation-associated ICH treated with reversal interventions.Design, Setting, and ParticipantsThis cohort study used data from the American Heart Association Get With The Guidelines–Stroke quality improvement registry. Patients with ICH who presented within 24 hours of symptom onset across 465 US hospitals from 2015 to 2021 were included. Data were analyzed from January to September 2023.ExposuresAnticoagulation-associated ICH.Main Outcomes and MeasuresDTT times and outcomes were analyzed using logistic regression modeling, adjusted for demographic, history, baseline, and hospital characteristics, with hospital-specific random intercepts to account for clustering by site. The primary outcome of interest was the composite inpatient mortality and discharge to hospice. Additional prespecified secondary outcomes, including functional outcome (discharge modified Rankin Scale score, ambulatory status, and discharge venue), were also examined.ResultsOf 9492 patients with anticoagulation-associated ICH and documented reversal intervention status, 4232 (44.6%) were female, and the median (IQR) age was 77 (68-84) years. A total of 7469 (78.7%) received reversal therapy, including 4616 of 5429 (85.0%) taking warfarin and 2856 of 4069 (70.2%) taking a non–vitamin K antagonist oral anticoagulant. For the 5224 patients taking a reversal intervention with documented workflow times, the median (IQR) onset-to-treatment time was 232 (142-482) minutes and the median (IQR) DTT time was 82 (58-117) minutes, with a DTT time of 60 minutes or less in 1449 (27.7%). A DTT time of 60 minutes or less was associated with decreased mortality and discharge to hospice (adjusted odds ratio, 0.82; 95% CI, 0.69-0.99) but no difference in functional outcome (ie, a modified Rankin Scale score of 0 to 3; adjusted odds ratio, 0.91; 95% CI, 0.67-1.24). Factors associated with a DTT time of 60 minutes or less included White race, higher systolic blood pressure, and lower stroke severity.Conclusions and RelevanceIn US hospitals participating in Get With The Guidelines–Stroke, earlier anticoagulation reversal was associated with improved survival for patients with ICH. These findings support intensive efforts to accelerate evaluation and treatment for patients with this devastating form of stroke.

中文翻译：

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脑出血后抗凝逆转的时间和结果

重要性脑出血 (ICH) 是最致命的中风亚型，抗凝相关 ICH 的死亡率特别高。近年来，特异性抗凝逆转策略已被开发出来，但临床实践中入院治疗时间（DTT）是否存在时间依赖性治疗效果尚不清楚。 目的评价DTT时间是否与患者预后相关。采用逆转干预措施治疗抗凝相关脑出血。设计、设置和参与者这项队列研究使用的数据来自美国心脏协会获取指南——卒中质量改善登记处。2015 年至 2021 年美国 465 家医院中出现症状 24 小时内出现的 ICH 患者被纳入研究。数据分析时间为 2023 年 1 月至 9 月。暴露抗凝相关 ICH。主要结果和测量使用 Logistic 回归模型分析 DTT 时间和结果，并根据人口、病史、基线和医院特征进行调整，并使用医院特定的随机截距来解释聚类按网站。感兴趣的主要结果是复合住院患者死亡率和出院到临终关怀中心。还检查了其他预先指定的次要结局，包括功能结局（出院改良 Rankin 量表评分、步行状态和出院地点）。 结果 在 9492 名患有抗凝相关脑出血并记录逆转干预状态的患者中，4232 名 (44.6%) 为女性，中位年龄 (IQR) 为 77 (68-84) 岁。共有 7469 人（78.7%）接受了逆转治疗，其中 5429 人中的 4616 人（85.0%）服用华法林，4069 人中的 2856 人（70.2%）服用非维生素 K 拮抗剂口服抗凝剂。对于 5224 名接受逆转干预并记录工作流程时间的患者，中位 (IQR) 发病到治疗时间为 232 (142-482) 分钟，中位 (IQR) DTT 时间为 82 (58-117) 分钟， 1449 人 (27.7%) 的 DTT 时间为 60 分钟或更少。60 分钟或更短的 DTT 时间与降低死亡率和出院到临终关怀中心相关（调整后的比值比，0.82；95% CI，0.69-0.99），但功能结果没有差异（即，改良 Rankin 量表评分为 0 至 3） ；调整后的比值比，0.91；95% CI，0.67-1.24）。与 60 分钟或更短 DTT 时间相关的因素包括白种人、较高的收缩压和较低的中风严重程度。结论和相关性在参与 Get With TheGuidelines-Stroke 项目的美国医院中，早期抗凝逆转与中风患者生存率的提高相关ICH。这些发现支持大力努力加快对这种破坏性中风患者的评估和治疗。