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Direct oral anticoagulant-vs vitamin k antagonist-related nontraumatic intracerebral hemorrhage
Tsivgoulis, Georgios Lioutas, Vasileios-Arsenios Varelas, Panayiotis Katsanos, Aristeidis H. Goyal, Nitin Mikulik, Robert Barlinn, Kristian Krogias, C. Sharma, Vijay K. Vadikolias, Konstantinos
Tsivgoulis, Georgios
Lioutas, Vasileios-Arsenios
Varelas, Panayiotis
Katsanos, Aristeidis H.
Goyal, Nitin
Mikulik, Robert
Barlinn, Kristian
Krogias, C.
Sharma, Vijay K.
Vadikolias, Konstantinos
Author
Tsivgoulis, Georgios
Lioutas, Vasileios-Arsenios
Varelas, Panayiotis
Katsanos, Aristeidis H.
Goyal, Nitin
Mikulik, Robert
Barlinn, Kristian
Krogias, C.
Sharma, Vijay K.
Vadikolias, Konstantinos
Dardiotis, E.
Karapanayiotides, Theodoros
Pappa, Alexandra
Zompola, Christina
Triantafyllou, Sokratis
Kargiotis, Odysseas
Ioakeimidis, Michael
Giannopoulos, Sotirios
Kerro, Ali
Tsantes, Argyrios
Mehta, Chandan
Jones, Mathew
Schroeder, Christoph
Norton, Casey
Bonakis, Anastasios
Chang, Jason
Alexandrov, Anne
Mitsias, Panayiotis D.
Alexandrov, Andrei V.
Lioutas, Vasileios-Arsenios
Varelas, Panayiotis
Katsanos, Aristeidis H.
Goyal, Nitin
Mikulik, Robert
Barlinn, Kristian
Krogias, C.
Sharma, Vijay K.
Vadikolias, Konstantinos
Dardiotis, E.
Karapanayiotides, Theodoros
Pappa, Alexandra
Zompola, Christina
Triantafyllou, Sokratis
Kargiotis, Odysseas
Ioakeimidis, Michael
Giannopoulos, Sotirios
Kerro, Ali
Tsantes, Argyrios
Mehta, Chandan
Jones, Mathew
Schroeder, Christoph
Norton, Casey
Bonakis, Anastasios
Chang, Jason
Alexandrov, Anne
Mitsias, Panayiotis D.
Alexandrov, Andrei V.
Abstract
Objective: To compare the neuroimaging profile and clinical outcomes among patients with intracerebral hemorrhage (ICH) related to use of vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF). Methods: We evaluated consecutive patients with NVAF with nontraumatic, anticoagulant-related ICH admitted at 13 tertiary stroke care centers over a 12-month period. We also performed a systematic review and meta-analysis of eligible observational studies reporting baseline characteristics and outcomes among patients with VKA- or DOAC-related ICH. Results: We prospectively evaluated 161 patients with anticoagulation-related ICH (mean age 75.6 ± 9.8 years, 57.8% men, median admission NIH Stroke Scale [NIHSSadm] score 13 points, interquartile range 6–21). DOAC-related (n = 47) and VKA-related (n = 114) ICH did not differ in demographics, vascular risk factors, HAS-BLED and CHA2DS2-VASc scores, and antiplatelet pretreatment except for a higher prevalence of chronic kidney disease in VKA-related ICH. Patients with DOAC-related ICH had lower median NIHSSadm scores (8 [3–14] vs 15 [7–25] points, p = 0.003), median baseline hematoma volume (12.8 [4–40] vs 24.3 [11–58.8] cm3, p = 0.007), and median ICH score (1 [0–2] vs 2 [1–3] points, p = 0.049). Severe ICH (>2 points) was less prevalent in DOAC-related ICH (17.0% vs 36.8%, p = 0.013). In multivariable analyses, DOAC-related ICH was independently associated with lower baseline hematoma volume (p = 0.006), lower NIHSSadm scores (p = 0.022), and lower likelihood of severe ICH (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.13–0.87, p = 0.025). In meta-analysis of eligible studies, DOAC-related ICH was associated with lower baseline hematoma volumes on admission CT (standardized mean difference = −0.57, 95% CI −1.02 to −0.12, p = 0.010) and lower in-hospital mortality rates (OR = 0.44, 95% CI 0.21–0.91, p = 0.030). Conclusions: DOAC-related ICH is associated with smaller baseline hematoma volume and lesser neurologic deficit at hospital admission compared to VKA-related ICH.
Keywords
Date
2017
Type
Journal article
Journal
Neurology
Book
Volume
89
Issue
11
Page Range
1142-1151
Article Number
ACU Department
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Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled