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 |
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Pages (from-to) | 1693-1700 |
Number of pages | 8 |
Journal | Neurology |
Volume | 88 |
Issue number | 18 |
Early online date | 5 Apr 2017 |
DOIs | |
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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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