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 HBM Schreuder, Luke A. Perry, Jun Tanaka, Marion Boulanger, Rustam Salman, Hans R Jäger, 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

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: In an international collaborative multi-center pooled analysis, we compared mortality, functional outcome, ICH volume and hematoma expansion (HE) between non-vitamin K antagonist oral anticoagulation-related intracerebral hemorrhage (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 GCS, ICH location and log volume; IVH volume; and intracranial surgery. We addressed heterogeneity using a shared frailty term. Good functional outcome was defined as discharge mRS ≤2 and investigated in multivariable logistic regression. ICH volume was measured by ABC/2 or a semi-automated planimetric method. HE was defined as an ICH volume increase >33% or >6 mL from baseline within 72 h. Results: We included 500 patients (97 NOAC-ICH and 403 VKA-ICH). Median baseline ICH volume was 14.4 mL (IQR 3.6 to 38.4) for NOAC-ICH vs. 10.6 mL (IQR 4.0 to 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 HR 0.93 (95% CI 0.52 to 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 vs. VKA-ICH: OR 0.47; 95% CI 0.18 to 1.19; p=0.11). Conclusions: In our international collaborative multi-center pooled analysis, baseline ICH volume, hematoma expansion, 90-day mortality and functional outcome were similar following NOAC-ICH and VKA-ICH.
Original languageEnglish
JournalNeurology
Early online date5 Apr 2017
DOIs
Publication statusE-pub ahead of print - 5 Apr 2017

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