Outcome of intracerebral hemorrhage associated with different oral anticoagulants

Author:

Wilson Duncan,Seiffge David J.,Traenka Christopher,Basir Ghazala,Purrucker Jan C.,Rizos Timolaos,Sobowale Oluwaseun A.,Sallinen Hanne,Yeh Shin-Joe,Wu Teddy Y.,Ferrigno Marc,Houben Rik,Schreuder Floris H.B.M.,Perry Luke A.,Tanaka Jun,Boulanger Marion,Al-Shahi Salman Rustam,Jäger Hans R.,Ambler Gareth,Shakeshaft Clare,Yakushiji Yusuke,Choi Philip M.C.,Staals Julie,Cordonnier Charlotte,Jeng Jiann-Shing,Veltkamp Roland,Dowlatshahi Dar,Engelter Stefan T.,Parry-Jones Adrian R.,Meretoja Atte,Werring David 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 VKA-ICH (p = 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 = 0.64]; adjusted Cox hazard ratio (for NOAC-ICH vs VKA-ICH) 0.93 [95% confidence interval (CI) 0.52–1.64] [p = 0.79]), the rate of HE (NOAC-ICH n = 29/48 [40%] vs VKA-ICH n = 93/140 [34%] [p = 0.45]), or functional outcome at hospital discharge (NOAC-ICH vs VKA-ICH odds ratio 0.47; 95% CI 0.18–1.19 [p = 0.11]).Conclusions:In our international collaborative multicenter pooled analysis, baseline ICH volume, hematoma expansion, 90-day mortality, and functional outcome were similar following NOAC-ICH and VKA-ICH.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical)

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