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Stroke. 2018 Oct;49(10):2309-2316. doi: 10.1161/STROKEAHA.118.021979.

Clinical Outcomes and Neuroimaging Profiles in Nondisabled Patients With Anticoagulant-Related Intracerebral Hemorrhage.

Author information

1
From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (V.-A.L., M.H.S.).
2
Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., A.P., A.K., A.V.A., G.T.).
3
Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., G.T.).
4
Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.).
5
Department of Neurology, St Josef-Hospital, Ruhr University of Bochum, Germany (C.K., C.S.).
6
Department of Neurology, Geisinger Medical Center, Danville, PA (R.Z., A.K.).
7
Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.).
8
Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., C.M., P.D.M.).
9
Department of Neurology, West Virginia University Charleston Division (K.M.).
10
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P.).
11
Department of Neurology, Essentia Health-Duluth Clinic, MN (A.S.).
12
Department of Critical Care Medicine, MedStar Washington Hospital Center, DC (J.C.).
13
Second Department of Neurology, AHEPA University Hospital, Aristotelian University of Thessaloniki, Greece (T.K.).
14
Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece (O.K.).
15
Department of Neurology, University of Thessaly, Larissa, Greece (A.P.).
16
Department of Neurosurgery Georgetown University, Washington, DC (J.M.).
17
Laboratory of Haematology and Blood Bank Unit, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.T.).
18
Department of Neurology, School of Medicine, University of Crete, Greece (P.D.M.).

Abstract

Background and Purpose- The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods- Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of <2 with acute nontraumatic anticoagulant-related ICH divided into 2 groups according to the type of anticoagulant: NOAC versus VKA. We recorded baseline ICH volume, significant hematoma expansion (absolute [12.5 mL] or relative [>33%] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results- Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0±11.4 years; 54.8% men) and 134 VKA related (mean age, 72.3±10.5; 73.1% men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37% versus 55.3%, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4% versus 17%, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:-0.415 [95% CI, -0.780 to -0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95% CI, 0.22-0.85) in multivariable-adjusted models. Conclusions- Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices.

KEYWORDS:

anticoagulants; brain; dabigatran; rivaroxaban; warfarin

PMID:
30355114
PMCID:
PMC6386175
DOI:
10.1161/STROKEAHA.118.021979
[Indexed for MEDLINE]
Free PMC Article

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