Scientists in Finland have found that among patients receiving oral anticoagulants (OACs), direct OACs (DOACs) were associated with lower rates of intracerebral haemorrhage (ICH) than the use of vitamin K antagonists (VKAs), according to their findings published in Annals of Medicine.
Medscape reports that the team, led by Liisa Tomppo of Helsinki University Hospital and University of Helsinki, conducted an observational study to examine how changes in prescribing OACs were associated with hospital admissions for OAC-related ICH.
The study compared two five-year cohorts: a pre‑DOAC era (2005-2009), during which all OAC use comprised VKAs, and a transition‑to‑DOAC era (2015-2019), reflecting an increasing uptake of DOACs.
The analysis included 917 patients from the pre-DOAC era and 1 002 patients from the transition-to-DOAC era, all admitted with an index event of non‑traumatic ICH confirmed by medical records and brain imaging.
ICH was attributed to VKA treatment if the international normalised ratio were less than 2.0 on admission, and DOAC-related ICH was confirmed through medical records, i.e, patient-/caregiver-confirmed medication use or anti-Xa assay, or electronic medication registry data.
Population‑level data on dispensed OACs were obtained annually from national pharmacy reimbursement registries.
During 2005-2009, 12.5% of ICH events were related to the use of OACs (all associated with VKAs); however, during 2015-2019, 18% of ICH events were related to the use of OACs, of which 27% were related to DOACs. The annual incidence of ICH was 12 per 100 000 inhabitants in both the cohorts.
During 2015-2019, the annual incidence of ICH was 5.4 per 10 000 DOAC users, representing a 34.2% lower incidence rate than VKA users (P = .011); however, the annual incidence of ICH did not differ significantly between the two cohorts for VKA users.
After multivariable adjustments, the use of DOACs was associated with a 52.7% lower rate of ICH than the use of VKAs (P < .001).
Support findings
“Our findings support the superior safety profile of DOACs compared with VKAs. With less restrictive compensation policies for DOACs, switching from VKAs to DOACs when clinically appropriate should eventually result in fewer OAC patients experiencing ICH,” the authors wrote.
Study details
Changes in the use of vitamin K antagonists and direct oral anticoagulants and impact on the incidence of oral anticoagulation-related intracerebral haemorrhage: population-wide prescription patterns in two 5-year cohorts
Liisa Tomppo, Hanne Sallinen, Otto Lankinen et al.
Published in Annals of Medicine on 6 April 2026
Abstract
Background
We investigated population-wide changes in prescriptions of oral anticoagulants (OAC) (vitamin K antagonists [VKA]) compared to direct oral anticoagulants (DOAC) and whether these translated into a decline in incidences of OAC-related intracerebral haemorrhages (ICH).
Methods
This observational study analysed OAC use in Southern Finland during 2005–2009 (pre-DOAC era) and 2015–2019 (transition-to-DOAC era) based on national registries. From medical records, we identified all non-traumatic ICH patients admitted to our tertiary hospital, the only one admitting neurological emergencies within the region. We compared the impact of DOACs versus VKAs on annual ICH incidence using an adjusted generalised additive model (GAM).
Results
The total population increased from 1.4 to 1.7 million between 2005 and 2019. The use of OACs increased from 1.65% of the population in 2005–2009 (100% VKA) to 2.97% in 2015–2019 (64% VKA, 36% DOAC), resulting in 368,055 person-years of OAC use. In 2019, DOAC use exceeded VKA use. The annual incidence of ICH was 12/100,000 person-years in both periods. During 2005–2009, 115 (13%) of 917 ICHs were OAC-related (100% VKA) compared to 178 (18%) of 1002 ICHs in 2015–2019 (73% VKA, 27% DOAC). In the GAM, the rate of ICH among patients on DOACs was 53% lower than among patients on VKA (p < 0.001).
Conclusions
ICH incidence remained stable despite near-doubled OAC use. The lower ICH rates with DOACs compared to VKAs support their safety advantage.
Medscape article – Direct Oral Anticoagulants Linked to Fewer Brain Bleeds (Open access)
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