Supplementary Material for: Blood Pressure and Anticoagulation Reversal Management during Off-Hours in Oral Anticoagulation-Associated Intracerebral Hemorrhage

Background: Prevention of hematoma enlargement in oral anticoagulation-associated intracerebral hemorrhage (OAC-ICH) focuses on blood pressure (BP) reduction and OAC reversal. We investigated whether treatment efficiency and clinical outcomes differ between OAC-ICH patients admitted outside versus during regular working hours. Methods: Based on pooled data of multicenter cohort studies, we grouped OAC-ICH patients (vitamin K antagonist [VKA], non-vitamin K oral anticoagulant [NOAC]) according to on- vs. off-hour admission. Primary outcome was the functional outcome using the modified Rankin scale (mRS) dichotomized into favorable (mRS 0–3) and unfavorable (mRS 4–6) and mortality at 3 months. Secondary outcome measures included the occurrence of hematoma enlargement, the proportions of patients with systolic BP Results: The study population consisted of 76/126 NOAC-ICH patients and 1,005/1,470 VKA patients presenting during off-hours. Functional outcome and mortality rates were not significantly different among PSM patients with VKA-ICH and NOAC-ICH during on- vs. off-hours (mRS 4–6 VKA-ICH: on-hour: 239/357 [66.9%] vs. 253/363 [69.7%] off-hour; p = 0.43; NOAC-ICH: on-hour 26/42 [61.9%] vs. off-hour: 37/57 [64.9%]; p = 0.76; mRS 6 VKA-ICH: on-hour: 127/357 [35.6%] vs. off-hour: 148/363 [40.8%]; p = 0.15; ­NOAC-ICH: on-hour 17/42 [40.5%] vs. off-hour: 16/57 [28.1%]; p = 0.20). There were no differences detectable regarding the secondary outcome measures (i.e., hematoma enlargement, the proportion of patients who achieved systolic BP levels Conclusion: Our study implies that BP reduction and anticoagulation reversal management are well established and associated with similar rates of hematoma enlargement and clinical outcomes in on- vs. off-hour admitted OAC-ICH patients.一、研究背景：口服抗凝药相关性脑出血（oral anticoagulation-associated intracerebral hemorrhage, OAC-ICH）的血肿扩大预防策略，核心聚焦于血压（blood pressure, BP）管控与口服抗凝药逆转治疗。本研究旨在探讨常规工作时段外与工作时段内收治的OAC-ICH患者，其治疗效果与临床结局是否存在差异。 二、研究方法：本研究基于多中心队列研究的合并数据，将OAC-ICH患者（分为维生素K拮抗剂（vitamin K antagonist, VKA）、非维生素K拮抗剂口服抗凝药（non-vitamin K oral anticoagulant, NOAC）两类）按入院时段分为工作时段内组与工作时段外组。主要结局指标为采用改良Rankin量表（modified Rankin scale, mRS）评估的功能结局，将其二分为预后良好组（mRS 0~3分）与预后不良组（mRS 4~6分），并以3个月死亡率作为主要结局指标之一。次要结局指标包括血肿扩大发生率、收缩压达标患者比例（原文表述未完整）。 三、研究结果：本研究队列中，工作时段外收治的NOAC-ICH患者共76/126例，VKA-ICH患者共1005/1470例。经倾向性得分匹配（propensity score matching, PSM）后的VKA-ICH与NOAC-ICH患者，无论收治于工作时段内还是时段外，其功能结局与死亡率均无显著差异：VKA-ICH患者中，mRS 4~6分占比在工作时段内组为239/357[66.9%]，时段外组为253/363[69.7%]（p=0.43）；mRS 6分占比在工作时段内组为127/357[35.6%]，时段外组为148/363[40.8%]（p=0.15）。NOAC-ICH患者中，mRS 4~6分占比在工作时段内组为26/42[61.9%]，时段外组为37/57[64.9%]（p=0.76）；mRS 6分占比在工作时段内组为17/42[40.5%]，时段外组为16/57[28.1%]（p=0.20）。次要结局指标（即血肿扩大发生率、收缩压达标患者比例）亦未观察到显著组间差异。 四、研究结论：本研究提示，针对OAC-ICH患者，无论收治于常规工作时段内还是时段外，血压管控与抗凝药逆转治疗的实施均较为规范，且两组患者的血肿扩大发生率与临床结局无显著差异。