Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin
Open Access
- 27 March 2018
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 90 (13), E1143-+
- https://doi.org/10.1212/WNL.0000000000005207
Abstract
Objectives This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)-associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database. Methods We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC-and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge. Results DOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039). Conclusions This nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.This publication has 42 references indexed in Scilit:
- Managing Bleeding in Anticoagulated Patients in the Emergency Care SettingThe Journal of Emergency Medicine, 2013
- The eye response test alone is sufficient to predict stroke outcome—reintroduction of Japan Coma Scale: a cohort studyBMJ Open, 2013
- New oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome: a systematic review and meta-analysisEuropean Heart Journal, 2013
- Intracranial Hemorrhage in Atrial Fibrillation Patients During Anticoagulation With Warfarin or DabigatranStroke, 2012
- Antithrombotic Therapy Influences Location, Enlargement, and Mortality from Intracerebral HemorrhageCerebrovascular Diseases, 2008
- Prediction of Functional Outcome in Patients With Primary Intracerebral HemorrhageStroke, 2008
- Dual Antithrombotic Therapy Increases Severe Bleeding Events in Patients With Stroke and Cardiovascular DiseaseStroke, 2008
- Hematoma Growth and Outcome in Treated Neurocritical Care Patients With Intracerebral Hemorrhage Related to Oral Anticoagulant TherapyStroke, 2006
- Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality.Stroke, 1993
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987