POST-NOAC: Portuguese observational study of intracranial hemorrhage on non-vitamin K antagonist oral anticoagulants
- 1 December 2016
- journal article
- research article
- Published by SAGE Publications in International Journal of Stroke
- Vol. 12 (6), 623-627
- https://doi.org/10.1177/1747493016681021
Abstract
Background: There is a lower reported incidence of intracranial hemorrhage with non-vitamin K antagonist oral anticoagulants compared with vitamin K antagonist. However, the functional outcome and mortality of intracranial hemorrhage patients were not assessed. Aims: To compare the outcome of vitamin K antagonists- and non-vitamin K antagonist oral anticoagulants-related intracranial hemorrhage. Methods: We included consecutive patients with acute non-traumatic intracranial hemorrhage on oral anticoagulation therapy admitted between January 2013 and June 2015 at four university hospitals. Clinical and demographic data were obtained from individual medical records. Intracranial hemorrhage was classified as intracerebral, extra-axial, or multifocal using brain computed tomography. Three-month functional outcome was assessed using the modified Rankin Scale. Results: Among 246 patients included, 24 (9.8%) were anticoagulated with a non-vitamin K antagonist oral anticoagulants and 222 (90.2%) with a vitamin K antagonists. Non-vitamin K antagonist oral anticoagulants patients were older (81.5 vs. 76 years, p = 0.048) and had intracerebral hemorrhage more often (83.3% vs. 63.1%, p = 0.048). We detected a non-significant trend for larger intracerebral hemorrhage volumes in vitamin K antagonists patients ( p = 0.368). Survival analysis adjusted for age, CHA2DS2VASc, HAS-BLED, and anticoagulation reversal revealed that non-vitamin K antagonist oral anticoagulants did not influence three-month mortality (hazard ratio (HR) = 0.83, 95% confidence interval (CI) = 0.39–1.80, p = 0.638). Multivariable ordinal regression for three-month functional outcome did not show a significant shift of modified Rankin Scale scores in non-vitamin K antagonist oral anticoagulants patients (odds ratio (OR) 1.26, 95%CI 0.55–2.87, p = 0.585). Conclusions: We detected no significant differences in the three-month outcome between non-vitamin K antagonist oral anticoagulants- and vitamin K antagonists-associated intracranial hemorrhage, despite unavailability of non-vitamin K antagonist oral anticoagulants-specific reversal agents.Keywords
This publication has 10 references indexed in Scilit:
- Early Clinical and Radiological Course, Management, and Outcome of Intracerebral Hemorrhage Related to New Oral AnticoagulantsJAMA Neurology, 2016
- Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant typeNeurology, 2016
- Characteristics of Intracerebral Hemorrhage During Rivaroxaban TreatmentStroke, 2014
- Intracranial Hemorrhage Mortality in Atrial Fibrillation Patients Treated With Dabigatran or WarfarinStroke, 2014
- Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trialsThe Lancet, 2014
- Edoxaban versus Warfarin in Patients with Atrial FibrillationThe 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
- User-guided 3D active contour segmentation of anatomical structures: Significantly improved efficiency and reliabilityNeuroImage, 2006