{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:47:05Z","timestamp":1791658025786,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>An unmet need exists to reliably predict the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) treated with oral anticoagulants (OACs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>An externally validated model improves ICH risk stratification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Independent factors associated with ICH were identified by Cox proportional hazard modeling, using pooled data from the GARFIELD\u2010AF (Global Anticoagulant Registry in the FIELD\u2010Atrial Fibrillation) and ORBIT\u2010AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registries. A predictive model was developed and validated by bootstrap sampling and by independent data from the Danish National Patient Register.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the combined training data set, 284 of 53\u2009878 anticoagulated patients had ICH over a 2\u2010year period (0.31 per 100 person\u2010years; 95% confidence interval [CI]: 0.28\u20130.35). Independent predictors of ICH included: older age, prior stroke or transient ischemic attack, concomitant antiplatelet (AP) use, and moderate\u2010to\u2010severe chronic kidney disease (CKD). Vitamin K antagonists (VKAs) were associated with a significantly higher risk of ICH compared with non\u2010VKA oral anticoagulants (NOACs) (adjusted hazard ratio: 1.61; 95% CI: 1.25\u20132.08; <jats:italic>p<\/jats:italic>\u2009=\u2009.0002). The ability of the model to discriminate individuals in the training set with and without ICH was fair (optimism\u2010corrected <jats:italic>C<\/jats:italic>\u2010statistic: 0.68; 95% CI: 0.65\u20130.71) and outperformed three previously published methods. Calibration between predicted and observed ICH probabilities was good in both training and validation data sets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Age, prior ischemic events, concomitant AP therapy, and CKD were important risk factors for ICH in anticoagulated AF patients. Moreover, ICH was more frequent in patients receiving VKA compared to NOAC. The new validated model is a step toward mitigating this potentially lethal complication.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.24109","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T18:15:50Z","timestamp":1692641750000},"page":"1398-1407","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Predictors of intracranial hemorrhage in patients with atrial fibrillation treated with oral anticoagulants: Insights from the GARFIELD\u2010AF and ORBIT\u2010AF registries"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3429-9237","authenticated-orcid":false,"given":"Toon Wei","family":"Lim","sequence":"first","affiliation":[{"name":"National Heart Centre Singapore  Singapore"},{"name":"National University Hospital Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2536-2871","authenticated-orcid":false,"given":"Alan John","family":"Camm","sequence":"additional","affiliation":[{"name":"Cardiology Clinical Academic Group Molecular &amp; Clinical Sciences Institute St. George's University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio","family":"Virdone","sequence":"additional","affiliation":[{"name":"Thrombosis Research Institute London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Singer","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean P.","family":"Bassand","sequence":"additional","affiliation":[{"name":"Thrombosis Research Institute London UK"},{"name":"Department of Cardiology University of Besan\u00e7on Besan\u00e7on France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3192-8093","authenticated-orcid":false,"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ronald Reagan\u2010UCLA Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith A. A.","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Science Centre for Cardiovascular Science, University of Edinburgh Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ezekowitz","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical School Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard J.","family":"Gersh","sequence":"additional","affiliation":[{"name":"Mayo Clinic College of Medicine and Science Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Kayani","sequence":"additional","affiliation":[{"name":"Thrombosis Research Institute London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine M.","family":"Hylek","sequence":"additional","affiliation":[{"name":"Department of Medicine Boston University School of Medicine 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