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 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

doi:10.1212/WNL.0000000000003886

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 journal › Article › Academic › 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 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
DOIs	https://doi.org/10.1212/WNL.0000000000003886
Publication status	Published - 2 May 2017

Keywords

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

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Cite this

Wilson, D., 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., Salman, R. A.-S., Jaeger, H. R., Ambler, G., ... CROMIS-2 Collaborators (2017). Outcome of intracerebral hemorrhage associated with different oral anticoagulants. Neurology, 88(18), 1693-1700. https://doi.org/10.1212/WNL.0000000000003886

@article{1bde198826b04d91985f0f6bf0f77d0a,

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 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 = "THROMBIN INHIBITOR DABIGATRAN, ATRIAL-FIBRILLATION, INTRACRANIAL HEMORRHAGE, WARFARIN, TRIAL, REVERSAL, RIVAROXABAN, VOLUME, IDARUCIZUMAB, MANAGEMENT",

author = "Duncan Wilson and 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 Salman, {Rustam Al-Shahi} and Jaeger, {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}",

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",

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Wilson, D, 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, Salman, RA-S, Jaeger, 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 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 - Wilson, Duncan

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 - Salman, Rustam Al-Shahi

AU - Jaeger, 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

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 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 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 - THROMBIN INHIBITOR DABIGATRAN

KW - ATRIAL-FIBRILLATION

KW - INTRACRANIAL HEMORRHAGE

KW - WARFARIN

KW - TRIAL

KW - REVERSAL

KW - RIVAROXABAN

KW - VOLUME

KW - IDARUCIZUMAB

KW - MANAGEMENT

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 -