Outcome of intracerebral hemorrhage associated with different oral anticoagulants

David J Seiffge; Christopher Traenka; Ghazala Basir; Jan C Purrucker; Timolaos Rizos; Oluwaseun A Sobowale; Hanne Sallinen; Shin-Joe Yeh; Teddy Y Wu; Marc Ferrigno; Rik Houben; Floris H B M Schreuder; Luke A Perry; Jun Tanaka; Marion Boulanger; Rustam Al-Shahi Salman; Hans R Jäger; Gareth Ambler; 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; David J Werring; CROMIS-2 collaborators; Duncan Wilson

doi:10.1212/WNL.0000000000003886

Outcome of intracerebral hemorrhage associated with different oral anticoagulants

David J Seiffge, Christopher Traenka, Ghazala Basir, Jan C Purrucker, Timolaos Rizos, Oluwaseun A Sobowale, Hanne Sallinen, Shin-Joe Yeh, Teddy Y Wu, Marc Ferrigno, Rik Houben, Floris H B M Schreuder, Luke A Perry, Jun Tanaka, Marion Boulanger, Rustam Al-Shahi Salman, Hans R Jäger, Gareth Ambler, Clare Shakeshaft, Yusuke YakushijiPhilip M C Choi, Julie Staals, Charlotte Cordonnier, Jiann-Shing Jeng, Roland Veltkamp, Dar Dowlatshahi, Stefan T Engelter, Adrian R Parry-Jones, Atte Meretoja, David J Werring, CROMIS-2 collaborators, Duncan Wilson

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: In an international collaborative multicenter pooled analysis, we compared mortality, functional outcome, intracerebral hemorrhage (ICH) volume, and hematoma expansion (HE) between non-vitamin K antagonist oral anticoagulation-related ICH (NOAC-ICH) and vitamin K antagonist-associated ICH (VKA-ICH).

METHODS: We compared all-cause mortality within 90 days for NOAC-ICH and VKA-ICH using a Cox proportional hazards model adjusted for age; sex; baseline Glasgow Coma Scale score, ICH location, and log volume; intraventricular hemorrhage volume; and intracranial surgery. We addressed heterogeneity using a shared frailty term. Good functional outcome was defined as discharge modified Rankin Scale score ≤2 and investigated in multivariable logistic regression. ICH volume was measured by ABC/2 or a semiautomated planimetric method. HE was defined as an ICH volume increase >33% or >6 mL from baseline within 72 hours.

RESULTS: We included 500 patients (97 NOAC-ICH and 403 VKA-ICH). Median baseline ICH volume was 14.4 mL (interquartile range [IQR] 3.6-38.4) for NOAC-ICH vs 10.6 mL (IQR 4.0-27.9) for VKA-ICH (p= 0.78). We did not find any difference between NOAC-ICH and VKA-ICH for all-cause mortality within 90 days (33% for NOAC-ICH vs 31% for VKA-ICH [p= 0.64]; adjusted Cox hazard ratio (for NOAC-ICH vs VKA-ICH) 0.93 [95% confidence interval (CI) 0.52-1.64] [p= 0.79]), the rate of HE (NOAC-ICH n = 29/48 [40%] vs VKA-ICH n = 93/140 [34%] [p= 0.45]), or functional outcome at hospital discharge (NOAC-ICH vs VKA-ICH odds ratio 0.47; 95% CI 0.18-1.19 [p= 0.11]).

CONCLUSIONS: In our international collaborative multicenter pooled analysis, baseline ICH volume, hematoma expansion, 90-day mortality, and functional outcome were similar following NOAC-ICH and VKA-ICH.

Original language	English
Pages (from-to)	1693-1700
Number of pages	8
Journal	Neurology
Volume	88
Issue number	18
Early online date	5 Apr 2017
DOIs	https://doi.org/10.1212/WNL.0000000000003886
Publication status	Published - 2 May 2017

Keywords

Administration, Oral
Anticoagulants
Cerebral Hemorrhage
Female
Glasgow Coma Scale
Humans
Logistic Models
Male
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Registries
Retrospective Studies
Survival Analysis
Treatment Outcome
Vitamin K
Comparative Study
Journal Article
Multicenter Study
Observational Study

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10.1212/WNL.0000000000003886

Reducing mortality via the ‘ABC’ care bundle for intracerebral haemorrhage (ICH)
Parry-Jones, A. (Corresponding participant), Patel, H. (Participant), Sutton, M. (Participant), Wilson, P. (Participant) & Brunton, L. (Participant)
Impact: Health and wellbeing

Cite this

Seiffge, D. J., Traenka, C., Basir, G., Purrucker, J. C., Rizos, T., Sobowale, O. A., Sallinen, H., Yeh, S.-J., Wu, T. Y., Ferrigno, M., Houben, R., Schreuder, F. H. B. M., Perry, L. A., Tanaka, J., Boulanger, M., Al-Shahi Salman, R., Jäger, H. R., Ambler, G., Shakeshaft, C., ... Wilson, D. (2017). Outcome of intracerebral hemorrhage associated with different oral anticoagulants. Neurology, 88(18), 1693-1700. https://doi.org/10.1212/WNL.0000000000003886

@article{262a08bcd29f4e889f1401d2ad2b4e52,

title = "Outcome of intracerebral hemorrhage associated with different oral anticoagulants",

abstract = "OBJECTIVE: In an international collaborative multicenter pooled analysis, we compared mortality, functional outcome, intracerebral hemorrhage (ICH) volume, and hematoma expansion (HE) between non-vitamin K antagonist oral anticoagulation-related ICH (NOAC-ICH) and vitamin K antagonist-associated ICH (VKA-ICH).METHODS: We compared all-cause mortality within 90 days for NOAC-ICH and VKA-ICH using a Cox proportional hazards model adjusted for age; sex; baseline Glasgow Coma Scale score, ICH location, and log volume; intraventricular hemorrhage volume; and intracranial surgery. We addressed heterogeneity using a shared frailty term. Good functional outcome was defined as discharge modified Rankin Scale score ≤2 and investigated in multivariable logistic regression. ICH volume was measured by ABC/2 or a semiautomated planimetric method. HE was defined as an ICH volume increase >33% or >6 mL from baseline within 72 hours.RESULTS: We included 500 patients (97 NOAC-ICH and 403 VKA-ICH). Median baseline ICH volume was 14.4 mL (interquartile range [IQR] 3.6-38.4) for NOAC-ICH vs 10.6 mL (IQR 4.0-27.9) for VKA-ICH (p= 0.78). We did not find any difference between NOAC-ICH and VKA-ICH for all-cause mortality within 90 days (33% for NOAC-ICH vs 31% for VKA-ICH [p= 0.64]; adjusted Cox hazard ratio (for NOAC-ICH vs VKA-ICH) 0.93 [95% confidence interval (CI) 0.52-1.64] [p= 0.79]), the rate of HE (NOAC-ICH n = 29/48 [40%] vs VKA-ICH n = 93/140 [34%] [p= 0.45]), or functional outcome at hospital discharge (NOAC-ICH vs VKA-ICH odds ratio 0.47; 95% CI 0.18-1.19 [p= 0.11]).CONCLUSIONS: In our international collaborative multicenter pooled analysis, baseline ICH volume, hematoma expansion, 90-day mortality, and functional outcome were similar following NOAC-ICH and VKA-ICH.",

keywords = "Administration, Oral, Anticoagulants, Cerebral Hemorrhage, Female, Glasgow Coma Scale, Humans, Logistic Models, Male, Multivariate Analysis, Proportional Hazards Models, Prospective Studies, Registries, Retrospective Studies, Survival Analysis, Treatment Outcome, Vitamin K, Comparative Study, Journal Article, Multicenter Study, Observational Study",

author = "Seiffge, {David J} and Christopher Traenka and Ghazala Basir and Purrucker, {Jan C} and Timolaos Rizos and Sobowale, {Oluwaseun A} and Hanne Sallinen and Shin-Joe Yeh and Wu, {Teddy Y} and Marc Ferrigno and Rik Houben and Schreuder, {Floris H B M} and Perry, {Luke A} and Jun Tanaka and Marion Boulanger and {Al-Shahi Salman}, Rustam and J{\"a}ger, {Hans R} and Gareth Ambler and Clare Shakeshaft and Yusuke Yakushiji and Choi, {Philip M C} and Julie Staals and Charlotte Cordonnier and Jiann-Shing Jeng and Roland Veltkamp and Dar Dowlatshahi and Engelter, {Stefan T} and Parry-Jones, {Adrian R} and Atte Meretoja and Werring, {David J} and {CROMIS-2 collaborators} and Duncan Wilson",

note = "Copyright {\textcopyright} 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.",

year = "2017",

month = may,

day = "2",

doi = "10.1212/WNL.0000000000003886",

language = "English",

volume = "88",

pages = "1693--1700",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams & Wilkins",

number = "18",

}

Seiffge, DJ, Traenka, C, Basir, G, Purrucker, JC, Rizos, T, Sobowale, OA, Sallinen, H, Yeh, S-J, Wu, TY, Ferrigno, M, Houben, R, Schreuder, FHBM, Perry, LA, Tanaka, J, Boulanger, M, Al-Shahi Salman, R, Jäger, HR, Ambler, G, Shakeshaft, C, Yakushiji, Y, Choi, PMC, Staals, J, Cordonnier, C, Jeng, J-S, Veltkamp, R, Dowlatshahi, D, Engelter, ST, Parry-Jones, AR, Meretoja, A, Werring, DJ, CROMIS-2 collaborators & Wilson, D 2017, 'Outcome of intracerebral hemorrhage associated with different oral anticoagulants', Neurology, vol. 88, no. 18, pp. 1693-1700. https://doi.org/10.1212/WNL.0000000000003886

TY - JOUR

T1 - Outcome of intracerebral hemorrhage associated with different oral anticoagulants

AU - Seiffge, David J

AU - Traenka, Christopher

AU - Basir, Ghazala

AU - Purrucker, Jan C

AU - Rizos, Timolaos

AU - Sobowale, Oluwaseun A

AU - Sallinen, Hanne

AU - Yeh, Shin-Joe

AU - Wu, Teddy Y

AU - Ferrigno, Marc

AU - Houben, Rik

AU - Schreuder, Floris H B M

AU - Perry, Luke A

AU - Tanaka, Jun

AU - Boulanger, Marion

AU - Al-Shahi Salman, Rustam

AU - Jäger, Hans R

AU - Ambler, Gareth

AU - Shakeshaft, Clare

AU - Yakushiji, Yusuke

AU - Choi, Philip M C

AU - Staals, Julie

AU - Cordonnier, Charlotte

AU - Jeng, Jiann-Shing

AU - Veltkamp, Roland

AU - Dowlatshahi, Dar

AU - Engelter, Stefan T

AU - Parry-Jones, Adrian R

AU - Meretoja, Atte

AU - Werring, David J

AU - CROMIS-2 collaborators

AU - Wilson, Duncan

PY - 2017/5/2

Y1 - 2017/5/2

N2 - OBJECTIVE: In an international collaborative multicenter pooled analysis, we compared mortality, functional outcome, intracerebral hemorrhage (ICH) volume, and hematoma expansion (HE) between non-vitamin K antagonist oral anticoagulation-related ICH (NOAC-ICH) and vitamin K antagonist-associated ICH (VKA-ICH).METHODS: We compared all-cause mortality within 90 days for NOAC-ICH and VKA-ICH using a Cox proportional hazards model adjusted for age; sex; baseline Glasgow Coma Scale score, ICH location, and log volume; intraventricular hemorrhage volume; and intracranial surgery. We addressed heterogeneity using a shared frailty term. Good functional outcome was defined as discharge modified Rankin Scale score ≤2 and investigated in multivariable logistic regression. ICH volume was measured by ABC/2 or a semiautomated planimetric method. HE was defined as an ICH volume increase >33% or >6 mL from baseline within 72 hours.RESULTS: We included 500 patients (97 NOAC-ICH and 403 VKA-ICH). Median baseline ICH volume was 14.4 mL (interquartile range [IQR] 3.6-38.4) for NOAC-ICH vs 10.6 mL (IQR 4.0-27.9) for VKA-ICH (p= 0.78). We did not find any difference between NOAC-ICH and VKA-ICH for all-cause mortality within 90 days (33% for NOAC-ICH vs 31% for VKA-ICH [p= 0.64]; adjusted Cox hazard ratio (for NOAC-ICH vs VKA-ICH) 0.93 [95% confidence interval (CI) 0.52-1.64] [p= 0.79]), the rate of HE (NOAC-ICH n = 29/48 [40%] vs VKA-ICH n = 93/140 [34%] [p= 0.45]), or functional outcome at hospital discharge (NOAC-ICH vs VKA-ICH odds ratio 0.47; 95% CI 0.18-1.19 [p= 0.11]).CONCLUSIONS: In our international collaborative multicenter pooled analysis, baseline ICH volume, hematoma expansion, 90-day mortality, and functional outcome were similar following NOAC-ICH and VKA-ICH.

AB - OBJECTIVE: In an international collaborative multicenter pooled analysis, we compared mortality, functional outcome, intracerebral hemorrhage (ICH) volume, and hematoma expansion (HE) between non-vitamin K antagonist oral anticoagulation-related ICH (NOAC-ICH) and vitamin K antagonist-associated ICH (VKA-ICH).METHODS: We compared all-cause mortality within 90 days for NOAC-ICH and VKA-ICH using a Cox proportional hazards model adjusted for age; sex; baseline Glasgow Coma Scale score, ICH location, and log volume; intraventricular hemorrhage volume; and intracranial surgery. We addressed heterogeneity using a shared frailty term. Good functional outcome was defined as discharge modified Rankin Scale score ≤2 and investigated in multivariable logistic regression. ICH volume was measured by ABC/2 or a semiautomated planimetric method. HE was defined as an ICH volume increase >33% or >6 mL from baseline within 72 hours.RESULTS: We included 500 patients (97 NOAC-ICH and 403 VKA-ICH). Median baseline ICH volume was 14.4 mL (interquartile range [IQR] 3.6-38.4) for NOAC-ICH vs 10.6 mL (IQR 4.0-27.9) for VKA-ICH (p= 0.78). We did not find any difference between NOAC-ICH and VKA-ICH for all-cause mortality within 90 days (33% for NOAC-ICH vs 31% for VKA-ICH [p= 0.64]; adjusted Cox hazard ratio (for NOAC-ICH vs VKA-ICH) 0.93 [95% confidence interval (CI) 0.52-1.64] [p= 0.79]), the rate of HE (NOAC-ICH n = 29/48 [40%] vs VKA-ICH n = 93/140 [34%] [p= 0.45]), or functional outcome at hospital discharge (NOAC-ICH vs VKA-ICH odds ratio 0.47; 95% CI 0.18-1.19 [p= 0.11]).CONCLUSIONS: In our international collaborative multicenter pooled analysis, baseline ICH volume, hematoma expansion, 90-day mortality, and functional outcome were similar following NOAC-ICH and VKA-ICH.

KW - Administration, Oral

KW - Anticoagulants

KW - Cerebral Hemorrhage

KW - Female

KW - Glasgow Coma Scale

KW - Humans

KW - Logistic Models

KW - Male

KW - Multivariate Analysis

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Registries

KW - Retrospective Studies

KW - Survival Analysis

KW - Treatment Outcome

KW - Vitamin K

KW - Comparative Study

KW - Journal Article

KW - Multicenter Study

KW - Observational Study

U2 - 10.1212/WNL.0000000000003886

DO - 10.1212/WNL.0000000000003886

M3 - Article

C2 - 28381513

SN - 0028-3878

VL - 88

SP - 1693

EP - 1700

JO - Neurology

JF - Neurology

IS - 18

ER -

Outcome of intracerebral hemorrhage associated with different oral anticoagulants

Abstract

Keywords

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Impacts

Reducing mortality via the ‘ABC’ care bundle for intracerebral haemorrhage (ICH)

Cite this