Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin.

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.

• Authors: Ryota Kurogi, Kunihiro Nishimura, Michikazu Nakai, Akiko Kada, Satoru Kamitani, Jyoji Nakagawara, Kazunori Toyoda, Kuniaki Ogasawara, Junichi Ono, Yoshiaki Shiokawa, Toru Aruga, Shigeru Miyachi, Izumi Nagata, Shinya Matsuda, Shinichi Yoshimura, Kazuo Okuchi, Akifumi Suzuki, Fumiaki Nakamura, Daisuke Onozuka, Keisuke Ido, Ai Kurogi, Nobutaka Mukae, Ataru Nishimura, Koichi Arimura, Takanari Kitazono, Akihito Hagihara, Koji Iihara, J-ASPECT Study Collaborators
• Journal: Neurology (Neurology) Vol. 90 Issue 13 Pg. e1143-e1149 (03 27 2018) ISSN: 1526-632X [Electronic] United States
• PMID: 29490916 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors
• Warfarin

Topics

• Administration, Oral
• Aged
• Anticoagulants (adverse effects, therapeutic use)
• Cerebral Hemorrhage (epidemiology, therapy)
• Comorbidity
• Cross-Sectional Studies
• Female
• Humans
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Propensity Score
• Severity of Illness Index
• Warfarin (adverse effects, therapeutic use)