{
  "abstract": "Introduction The association between systemic anticoagulation and the risk of intracranial aneurysm rupture remains undefined. Although anticoagulants increase the risk of hemorrhagic complications in other pathologies, their role in aneurysmal subarachnoid hemorrhage (aSAH) has not been well established. We investigate whether anticoagulant use is correlated with aneurysmal rupture at clinical presentation.Methods 1,267 patients who underwent surgical or endovascular treatment for intracranial aneurysms at two tertiary care centers were stratified by rupture status at presentation. Anticoagulant use was defined as active administration of warfarin, heparin, apixaban, dabigatran, or rivaroxaban at time of presentation. Multivariable logistic regression was performed to assess the association between anticoagulation and rupture status, adjusting for age, sex, race/ethnicity, hypertension, and smoking history.Results Among 1,267 patients, 154 (12.2%) presented with ruptured aneurysms and 1,113 (87.8%) with unruptured aneurysms. Anticoagulant use was observed in 289 patients (22.8%). In unadjusted analysis, there was no significant difference in anticoagulant use between patients with ruptured and unruptured aneurysms (p=0.522). In adjusted logistic regression, anticoagulation was not independently associated with rupture (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.71-1.84, p=0.585). Variables independently associated with rupture included younger age (OR 0.98 per year, p=0.026), Asian race (OR 5.85, 95% CI 2.98-11.47, p<0.001), unknown race (OR 5.02, 95% CI 2.22-11.32, p<0.001), hypertension (OR 1.60, 95% CI 1.04-2.47, p=0.032), and former or current smoking history (OR 1.70, 95% CI 1.12-2.57, p=0.013). Male sex, Black race, Hispanic ethnicity, cardiovascular disease, chronic kidney disease, and active cancer diagnosis were not significantly associated with rupture status.Conclusions In this cohort, systemic anticoagulant use was not associated with increased odds of presenting with aSAH. These findings suggest that anticoagulation alone does not confer elevated rupture risk and may not be an independent contraindication to expectant management of unruptured aneurysms. Traditional risk factors, including hypertension and smoking, remained significantly associated with rupture.Disclosures A. Gajjar: None. A. Custozzo: None. M. Lanka: None. V. Srinivasan: None. A. Boulos: None.Abstract E-001 Figure 1Abstract E-001 Figure 2",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Albany Medical College, Albany, NY"
      ],
      "name": "A Gajjar"
    },
    {
      "affiliations": [
        "Neurosurgery, Albany Medical College, Albany, NY"
      ],
      "name": "A Custozzo"
    },
    {
      "affiliations": [
        "Neurosurgery, Albany Medical College, Albany, NY"
      ],
      "name": "M Lanka"
    },
    {
      "affiliations": [
        "Neurosurgery/Neuroradiology, Penn Medicine, Gladwyne, Germany"
      ],
      "name": "R Jabarkheel"
    },
    {
      "affiliations": [
        "Neurosurgery/Neuroradiology, Penn Medicine, Gladwyne, Germany"
      ],
      "name": "J Burkhardt"
    },
    {
      "affiliations": [
        "Neurosurgery, Perleman School of Medicine, Philadelphia, PA"
      ],
      "name": "V Srinivasan"
    },
    {
      "affiliations": [
        "Neurosurgery, Albany Medical College, Albany, NY"
      ],
      "name": "A Boulos"
    },
    {
      "affiliations": [
        "Neurosurgery, Albany Medical Center, Albany, NY"
      ],
      "name": "J Dalfino"
    },
    {
      "affiliations": [
        "Albany, NY"
      ],
      "name": "A Paul"
    }
  ],
  "title": "E-001 Multicenter analysis of anticoagulation usage and likelihood of presentation with intracranial aneurysm rupture",
  "uid": "59a7fca5-d57e-51ef-9f19-d6b0fdbcb51a"
}