Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage

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 PurruckerVijay 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 Mitsias, Andrei V Alexandrov, Gareth Ambler, David J Werring

Research output: Contribution to journalArticlepeer-review

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 < 30cm 3 (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.

Original languageEnglish
Pages (from-to)694-704
Number of pages11
JournalAnnals of Neurology
Volume84
Issue number5
Early online date26 Sept 2018
DOIs
Publication statusPublished - 1 Nov 2018

Fingerprint

Dive into the research topics of 'Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage'. Together they form a unique fingerprint.

Cite this