Clinical Outcomes and Neuroimaging Profiles in Nondisabled Patients With Anticoagulant-Related Intracerebral Hemorrhage
- 1 October 2018
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 49 (10), 2309-2316
- https://doi.org/10.1161/STROKEAHA.118.021979
Abstract
Background and Purpose-The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods-Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of 33%] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results-Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0 +/- 11.4 years; 54.8% men) and 134 VKA related (mean age, 72.3 +/- 10.5; 73.1% men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37% versus 55.3%, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4% versus 17%, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:-0.415 [95% CI, -0.780 to -0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95% CI, 0.22-0.85) in multivariable-adjusted models. Conclusions-Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices.This publication has 22 references indexed in Scilit:
- Association of Intracerebral Hemorrhage Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital MortalityJAMA, 2018
- Outcome of intracerebral haemorrhage related to non-vitamin K antagonists oral anticoagulants versus vitamin K antagonists: a comprehensive systematic review and meta-analysisJournal of Neurology, Neurosurgery & Psychiatry, 2017
- Direct oral anticoagulant– vs vitamin K antagonist–related nontraumatic intracerebral hemorrhageNeurology, 2017
- Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta‐AnalysisJournal of the American Heart Association, 2016
- Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant typeNeurology, 2016
- Intracranial Hemorrhage Among Patients With Atrial Fibrillation Anticoagulated With Warfarin or RivaroxabanStroke, 2014
- Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral HemorrhageThe New England Journal of Medicine, 2013
- Intracranial Hemorrhage in Atrial Fibrillation Patients During Anticoagulation With Warfarin or DabigatranStroke, 2012
- Apixaban versus Warfarin in Patients with Atrial FibrillationThe New England Journal of Medicine, 2011
- Rivaroxaban versus Warfarin in Nonvalvular Atrial FibrillationThe New England Journal of Medicine, 2011