Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage

Georgios Tsivgoulis, Duncan Wilson, Aristeidis H. Katsanos, Joao Sargento-Freitas, Claudia Marques-Matos, Elsa Azevedo, Tomohide Adachi, Christian 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, Joao-Pedro Marto, Joao Pinho, Jun Tanaka, Marion Boulanger, Rustam Al-Shahi Salman, Hans R. Jaeger, 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*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

30 Citations (Web of Science)

Abstract

Objective Methods 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. 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 Interpretation 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). 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
DOIs
Publication statusPublished - 1 Nov 2018

Keywords

  • VITAMIN-K ANTAGONIST
  • INTRACRANIAL HEMORRHAGE
  • ANTITHROMBOTIC THERAPY
  • CEREBRAL MICROBLEEDS
  • ATRIAL-FIBRILLATION
  • RADIOLOGICAL COURSE
  • HEMATOMA VOLUME
  • WARFARIN
  • STROKE
  • METAANALYSIS

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