Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage.

Abstract

OBJECTIVE:

Whether intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain.

METHODS:

We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension.

RESULTS:

We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs 26.5%; hazard ratio = 0.94, 95% confidence interval [CI] = 0.67-1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = -2.83, 95% CI = -5.28 to -0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30-0.84), and smaller baseline hematoma volume (linear regression coefficient = -0.24, 95% CI = -0.47 to -0.16). The two groups did not differ in the likelihood of baseline hematoma volume < 30cm3 (OR = 1.14, 95% CI = 0.81-1.62), hematoma expansion (OR = 0.97, 95% CI = 0.63-1.48), in-hospital mortality (OR = 0.73, 95% CI = 0.49-1.11), functional status at discharge (common OR = 0.78, 95% CI = 0.57-1.07), or functional status at 3 months (common OR = 1.03, 95% CI = 0.75-1.43).

INTERPRETATION:

Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702-712.

• Authors: Georgios Tsivgoulis, Duncan Wilson, Aristeidis H Katsanos, João Sargento-Freitas, Cláudia Marques-Matos, Elsa Azevedo, Tomohide Adachi, Christian von der Brelie, Yoshifusa Aizawa, Hiroshi Abe, Hirofumi Tomita, Ken Okumura, Joji Hagii, David J Seiffge, Vasileios-Arsenios Lioutas, Christopher Traenka, Panayiotis Varelas, Ghazala Basir, Christos Krogias, Jan C Purrucker, Vijay K Sharma, Timolaos Rizos, Robert Mikulik, Oluwaseun A Sobowale, Kristian Barlinn, Hanne Sallinen, Nitin Goyal, Shin-Joe Yeh, Theodore Karapanayiotides, Teddy Y Wu, Konstantinos Vadikolias, Marc Ferrigno, Georgios Hadjigeorgiou, Rik Houben, Sotirios Giannopoulos, Floris H B M Schreuder, Jason J Chang, Luke A Perry, Maximilian Mehdorn, João-Pedro Marto, João Pinho, Jun Tanaka, Marion Boulanger, Rustam Al-Shahi Salman, Hans R Jäger, Clare Shakeshaft, Yusuke Yakushiji, Philip M C Choi, Julie Staals, Charlotte Cordonnier, Jiann-Shing Jeng, Roland Veltkamp, Dar Dowlatshahi, Stefan T Engelter, Adrian R Parry-Jones, Atte Meretoja, Panayiotis D Mitsias, Andrei V Alexandrov, Gareth Ambler, David J Werring
• Journal: Annals of neurology (Ann Neurol) Vol. 84 Issue 5 Pg. 694-704 (11 2018) ISSN: 1531-8249 [Electronic] United States
• PMID: 30255970 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: © 2018 American Neurological Association.

Chemical References

• Anticoagulants
• Vitamin K

Topics

• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage, adverse effects)
• Cerebral Hemorrhage (chemically induced, mortality, pathology)
• Female
• Humans
• Male
• Middle Aged
• Neuroimaging
• Vitamin K (antagonists & inhibitors)