Impact of Code Stroke Activation and Warfarin Use on Time to Anticoagulation Reversal in Intracerebral Hemorrhage: Implications For Quality Improvement

The study examined the impact of Code Stroke activation and warfarin use on anticoagulation reversal times in patients with anticoagulation-associated intracerebral hemorrhage. Among 892 intracerebral hemorrhage admissions, 50 patients had confirmed anticoagulation-associated cases. Code Stroke activation significantly reduced door-to-CT time (16.5 versus 172.5 minutes), reversal agent order-to-needle time (37.5 versus 57.0 minutes), and door-to-treatment time (64 versus 277 minutes) compared to non-activation. Patients using warfarin had higher INR values and longer treatment times compared to those on direct oral anticoagulants. Main causes of delays included absence of time-critical protocols, waiting for INR results, and insufficient Code Stroke activation for patients with milder symptoms. The study recommends Code Stroke activation for all suspected intracerebral hemorrhage cases and implementation of an algorithm targeting treatment within 60 minutes.