Outcome of intracerebral hemorrhage associated with different oral anticoagulants
Journal
Neurology
Journal Volume
88
Journal Issue
18
Pages
1693-1700
Date Issued
2017
Author(s)
Wilson D.
Seiffge D.J.
Traenka C.
Basir G.
Purrucker J.C.
Rizos T.
Sobowale O.A.
Sallinen H.
Wu T.Y.
Ferrigno M.
Houben R.
Schreuder F.H.B.M.
Perry L.A.
Tanaka J.
Boulanger M.
Salman R.A.-S.
J?ger H.R.
Ambler G.
Shakeshaft C.
Yakushiji Y.
Choi P.M.C.
Staals J.
Cordonnier C.
Veltkamp R.
Dowlatshahi D.
Engelter S.T.
Parry-Jones A.R.
Meretoja A.
Werring D.J.
Abstract
Objective: In an international collaborative multicenter pooled analysis, we compared mortality, functional outcome, intracerebral hemorrhage (ICH) volume, and hematoma expansion (HE) between non-vitamin K antagonist oral anticoagulation-related ICH (NOAC-ICH) and vitamin K antagonist-associated ICH (VKA-ICH). Methods: We compared all-cause mortality within 90 days for NOAC-ICH and VKA-ICH using a Cox proportional hazards model adjusted for age; sex; baseline Glasgow Coma Scale score, ICH location, and log volume; intraventricular hemorrhage volume; and intracranial surgery. We addressed heterogeneity using a shared frailty term. Good functional outcome was defined as discharge modified Rankin Scale score #2 and investigated in multivariable logistic regression. ICH volume was measured by ABC/2 or a semiautomated planimetric method. HE was defined as an ICH volume increase .33% or .6 mL from baseline within 72 hours. Results: We included 500 patients (97 NOAC-ICH and 403 VKA-ICH). Median baseline ICH volume was 14.4 mL (interquartile range [IQR] 3.6-38.4) for NOAC-ICH vs 10.6 mL (IQR 4.0-27.9) for VKAICH (p 5 0.78). We did not find any difference between NOAC-ICH and VKA-ICH for all-cause mortality within 90 days (33%for NOAC-ICH vs 31% for VKA-ICH [p 5 0.64]; adjusted Cox hazard ratio (for NOAC-ICH vs VKA-ICH) 0.93 [95% confidence interval (CI) 0.52-1.64] [p 5 0.79]), the rate of HE (NOAC-ICH n 5 29/48 [40%] vs VKA-ICH n 5 93/140 [34%] [p 5 0.45]), or functional outcome at hospital discharge (NOAC-ICH vs VKA-ICH odds ratio 0.47; 95% CI 0.18-1.19 [p 5 0.11]). Conclusions: In our international collaborative multicenter pooled analysis, baseline ICH volume, hematoma expansion, 90-day mortality, and functional outcome were similar following NOACICH and VKA-ICH. ? Copyright 2017 The Author(s).
SDGs
Other Subjects
anticoagulant agent; antivitamin K; apixaban; dabigatran; rivaroxaban; anticoagulant agent; vitamin K group; aged; anticoagulant therapy; anticoagulation; Article; atrial fibrillation; Australia; brain hemorrhage; brain surgery; Canada; female; Finland; frailty; France; functional assessment; Germany; Glasgow coma scale; hematoma; hospital discharge; human; international normalized ratio; Japan; major clinical study; male; mortality; mortality rate; multicenter study (topic); Netherlands; neurosurgery; outcome assessment; patient selection; priority journal; Rankin scale; retrospective study; Switzerland; Taiwan; United Kingdom; very elderly; antagonists and inhibitors; Cerebral Hemorrhage; clinical trial; comparative study; mortality; multicenter study; multivariate analysis; oral drug administration; pathology; proportional hazards model; prospective study; register; statistical model; survival analysis; treatment outcome; Administration, Oral; Anticoagulants; Cerebral Hemorrhage; Female; Glasgow Coma Scale; Humans; Logistic Models; Male; Multivariate Analysis; Proportional Hazards Models; Prospective Studies; Registries; Retrospective Studies; Survival Analysis; Treatment Outcome; Vitamin K
Type
journal article