Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type.

Abstract

OBJECTIVE:

To compare intracerebral hemorrhage (ICH) volume and clinical outcome of non-vitamin K oral anticoagulants (NOAC)-associated ICH to warfarin-associated ICH.

METHODS:

In this multicenter cross-sectional observational study of patients with anticoagulant-associated ICH, consecutive patients with NOAC-ICH were compared to those with warfarin-ICH selected from a population of 344 patients with anticoagulant-associated ICH. ICH volume was measured by an observer blinded to clinical details. Outcome measures were ICH volume and clinical outcome adjusted for confounding factors.

RESULTS:

We compared 11 patients with NOAC-ICH to 52 patients with warfarin-ICH. The median ICH volume was 2.4 mL (interquartile range [IQR] 0.3-5.4 mL) for NOAC-ICH vs 8.9 mL (IQR 4.0-21.3 mL) for warfarin-ICH (p = 0.0028). In univariate linear regression, use of warfarin (difference in cube root volume 1.61; 95% confidence interval [CI] 0.69 to 2.53) and lobar ICH location (compared with nonlobar ICH; difference in cube root volume 1.52; 95% CI 2.20 to 0.85) were associated with larger ICH volumes. In multivariable linear regression adjusting for confounding factors (sex, hypertension, previous ischemic stroke, white matter disease burden, and premorbid modified Rankin Scale score [mRS]), warfarin use remained independently associated with larger ICH (cube root) volumes (coefficient 0.64; 95% CI 0.24 to 1.25; p = 0.042). Ordered logistic regression showed an increased odds of a worse clinical outcome (as measured by discharge mRS) in warfarin-ICH compared with NOAC-ICH: odds ratio 4.46 (95% CI 1.10 to 18.14; p = 0.037).

CONCLUSIONS:

In this small prospective observational study, patients with NOAC-associated ICH had smaller ICH volumes and better clinical outcomes compared with warfarin-associated ICH.

• Authors: Duncan Wilson, Andreas Charidimou, Clare Shakeshaft, Gareth Ambler, Mark White, Hannah Cohen, Tarek Yousry, Rustam Al-Shahi Salman, Gregory Y H Lip, Martin M Brown, Hans Rolf Jäger, David J Werring, CROMIS-2 collaborators
• Journal: Neurology (Neurology) Vol. 86 Issue 4 Pg. 360-6 (Jan 26 2016) ISSN: 1526-632X [Electronic] United States
• PMID: 26718576 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 American Academy of Neurology.

Chemical References

• Anticoagulants
• Warfarin

Topics

• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage, adverse effects)
• Cerebral Hemorrhage (chemically induced, pathology)
• Cross-Sectional Studies
• Female
• Humans
• Male
• Outcome Assessment, Health Care
• Warfarin (administration & dosage, adverse effects)