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 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

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 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

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Abstract / Description of output

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 language	English
Journal	Neurology
Early online date	5 Apr 2017
DOIs	https://doi.org/10.1212/WNL.0000000000003886
Publication status	E-pub ahead of print - 5 Apr 2017

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10.1212/WNL.0000000000003886

Outcome of intracerebral hemorrhage associated with different oral anticoagulants
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http://www.neurology.org/content/early/2017/04/05/WNL.0000000000003886.abstract

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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. HBM., Perry, L. A., Tanaka, J., Boulanger, M., Salman, R., Jäger, H. R., Ambler, G., ... Werring, D. J. (2017). Outcome of intracerebral hemorrhage associated with different oral anticoagulants. Neurology. Advance online publication. https://doi.org/10.1212/WNL.0000000000003886

@article{d6d0e73da9044abb8dff23210cf0d8f2,

title = "Outcome of intracerebral hemorrhage associated with different oral anticoagulants",

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.",

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 HBM} and Perry, {Luke A.} and Jun Tanaka and Marion Boulanger and Rustam Salman and J{\"a}ger, {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.}",

year = "2017",

month = apr,

day = "5",

doi = "10.1212/WNL.0000000000003886",

language = "English",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins",

}

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, R, Jäger, 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 2017, 'Outcome of intracerebral hemorrhage associated with different oral anticoagulants', Neurology. 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 HBM

AU - Perry, Luke A.

AU - Tanaka, Jun

AU - Boulanger, Marion

AU - Salman, Rustam

AU - Jäger, 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.

PY - 2017/4/5

Y1 - 2017/4/5

N2 - 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.

AB - 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.

U2 - 10.1212/WNL.0000000000003886

DO - 10.1212/WNL.0000000000003886

M3 - Article

SN - 0028-3878

JO - Neurology

JF - Neurology

ER -

Outcome of intracerebral hemorrhage associated with different oral anticoagulants

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