Outcome of intracerebral hemorrhage associated with different oral anticoagulants

Duncan Wilson, 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. Jaeger, Gareth Ambler, Clare ShakeshaftYusuke 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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

91 Citations (Web of Science)

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 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 languageEnglish
Pages (from-to)1693-1700
Number of pages8
JournalNeurology
Volume88
Issue number18
DOIs
Publication statusPublished - 2 May 2017

Keywords

  • THROMBIN INHIBITOR DABIGATRAN
  • ATRIAL-FIBRILLATION
  • INTRACRANIAL HEMORRHAGE
  • WARFARIN
  • TRIAL
  • REVERSAL
  • RIVAROXABAN
  • VOLUME
  • IDARUCIZUMAB
  • MANAGEMENT

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