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Neurology. 2018 Mar 27;90(13):e1143-e1149. doi: 10.1212/WNL.0000000000005207. Epub 2018 Feb 28.

Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin.

Collaborators (689)

Takigami M, Kamiyama K, Houkin K, Nishi S, Yoshimoto T, Kaneko S, Oka K, Nakagaki Y, Ooyama H, Kamada K, Makino K, Tokumitsu N, Sako K, Tokumitsu N, Suzuki S, Suzuki N, Kimura T, Izumi N, Nitta K, Ootaki M, Isobe M, Nishiya M, Yamazaki T, Mabuchi S, Ogasawara K, Kubo N, Shimizu Y, Saito K, Yamanome T, Yabuta A, Suzuki A, Yoshino A, Harashina J, Fujitsuka M, Masaoka H, Takami M, Ohtaka H, Hirano T, Shiokawa Y, Okada T, Suzuki I, Kohno M, Haraoka J, Arai Y, Kawamura N, Isoshima A, Yasue M, Hokari M, Kobayashi T, Kawai K, Maehara T, Arai H, Kawamata T, Okada Y, Noguchi M, Hoshino H, Hiyama H, Yoshida K, Fujitsuka M, Utsugi O, Takeda Y, Tamaki K, Karasudani H, Urabe T, Kobayashi S, Nakamura M, Koguchi Y, Ono J, Suda S, Hadeishi H, Fukutake T, Wakui K, Tanno H, Ishige N, Ohasi T, Sato N, Sakai H, Nishimura Y, Watanabe T, Matsumoto T, Koketsu N, Hirose Y, Doyu M, Hasegawa T, Kuwayama N, Terao S, Mizutani N, Suzaki N, Okuda S, Yasui K, Seki Y, Hasegawa Y, Ikeda A, Takeuchi Y, Ohara S, Araki Y, Wakabayashi T, Tanaka H, Yoshimoto J, Sugiura M, Koichiro O, Kobayashi N, Yokoe T, Murao K, Yamada T, Kato A, Ohtsuki T, Wakayama A, Takahashi J, Kataoka H, Yoshimine T, Nakajima Y, Gi H, Uranishi R, Nakamura Y, Yamanaka K, Ohmori K, Matsumoto H, Oiwa Y, Uemura Y, Fujiwara H, Iwai Y, Morikawa M, Tane K, Hashikawa K, Fujinaka T, Yoneda S, Yamashita K, Kitano M, Tominaga S, Nakamura K, Kono K, Ohata K, Taniguchi H, Hazama T, Kuroiwa T, Tamura Y, Maeno K, Arai M, Iwase M, Hashimoto K, Yamada K, Turuno T, Ichinose T, Kurokawa S, Matsuyama T, Fujita T, Yuguchi T, Teramoto Y, Kakita H, Matsuo T, Izumo T, Ryu N, Haraguchi W, Kitagawa N, Kaminogo M, Sakamoto S, Tokunaga Y, Urasaki EI, Kuratsu J, Takada A, Terasaki T, Nishi T, Fuwa I, Ooshima H, Yamashiro S, Yoshikawa M, Tsuiki H, Koga K, Egami H, Nagatomi H, Kawamura T, Goda M, Takeda Y, Mitsuo K, Hikawa T, Morisige M, Takeda Y, Yamaguchi Y, Miyata S, Uchinokura S, Goya T, Takeshima H, Yatsushiro K, Ohta H, Nagadou T, Hirahara K, Obara S, Seto H, Tanaka S, Moroki K, Arita K, Ishiuchi S, Uchihara T, Mekaru S, Nagamine T, Tomiyama N, Momoji J, Yamamoto S, Idomari K, Kimoto A, Kadekaru T, Syamoto H, Sasaki O, Minagawa M, Fujii Y, Takahashi H, Onda K, Arai H, Takeuchi S, Abe H, Fukuda O, Kouno M, Tamura T, Horie Y, Kubo M, Hondo H, Miyamori T, Takada H, Masuoka T, Shirasaki N, Nitta H, Kimura M, Katsuki Y, Hayashi Y, Minamide H, Munemoto S, Shiraga S, Ikeda K, Nakada M, Hayashi Y, Sato S, Hatano T, Yamamura O, Kabuto M, Sakuma T, Hayashi J, Kinouchi H, Koizumi H, Uchida M, Imae S, Ozawa H, Nishizaki O, Fujita M, Suga M, Iwata S, Kohno K, Kunieda T, Zenke K, Fujisawa M, Sadashima H, Mizobuchi H, Hayashi S, Morimoto M, Kohno T, Ueba T, Nishimura H, Ikawa N, Matsumoto Y, Kannuki S, Kagawa M, Hayashi N, Tamiya T, Shindo A, Yoshino K, Masaoka T, Nakahara I, Nakamizo A, Okamoto Y, Kin S, Takahashi H, Suzuki S, Iihara K, Hirakawa K, Nagata S, Ookura A, Matsukado K, Yoshida H, Kaneko Y, Nakane H, Inoue I, Yoshihisa M, Hisada K, Hitotsumatsu T, Kuramoto T, Kuramoto K, Hayashi J, Matumoto Y, Ooishi H, Inoue T, Nonaka M, Morioka M, Mizoguchi M, Tsukamoto H, Sugimori H, Sakata S, Takashima H, Ishihara SI, Suzuyama K, Momozaki N, Miyazono M, Morimoto M, Hattori I, Ozaki S, Hirota N, Takemoto Y, Mochimatsu Y, Takagi M, Yamamoto I, Nakayama K, Uchida Y, Tanaka H, Sakata K, Nobutaka K, Nomura M, Ozawa H, Tsumura K, Inaba M, Maruyama M, Mori T, Terada T, Mori T, Sugitani M, Tanaka Y, Yamada M, Matsumae M, Onitsuka K, Miyahara K, Takahashi T, Endou S, Kojima A, Takahashi H, Kaidu H, Tsunoda A, Maruki C, Nomura K, Matsui T, Fujimaki T, Ooigawa H, Tanaka M, Uchida M, Wanihuti H, Katoh K, Wada H, Hyodo A, Asakura K, Nakajima S, Kanzawa T, Kurihara H, Ohmori S, Mitsugi Y, Kusunoki H, Magarisawa S, Okabe S, Kujiraoka Y, Tsuruoka S, Takeshita M, Yamamoto T, Matsumura A, Uemura K, Tabata H, Sonobe M, Nakatsukasa M, Yoshida R, Shimoeda N, Kunimine H, Ishihara M, Teduka M, Murai N, Taki W, Murakami N, Kidooka M, Iwamoto Y, Tenjin H, Shiga K, Takamasu M, Mori N, Kose S, Kohmura E, Yamashita H, Matsumoto K, Takeda N, Sakaki T, Miyake H, Mabuchi E, Yokota M, Ohnishi H, Kuga Y, Kimura M, Narumi O, Saiki M, Nakajima N, Asahi M, Koyama J, Sakagami Y, Noda S, Iida J, Fujita T, Nakase H, Hirabayashi H, Hoshida T, Fujimoto T, Nakao N, Tanaka Y, Ozaki F, Nakamura Y, Miki K, Habu T, Watanabe T, Ohkuma H, Hasegawa S, Konno H, Takemura A, Okubo A, Saito H, Ishikawa T, Nakase T, Shimizu H, Sasajima T, Sasou M, Watanabe Y, Sato T, Saito K, Taira S, Satoh M, Watanabe Z, Koizumi T, Suzuki Y, Mashiyama S, Oikawa T, Sonoda Y, Kondo R, Saito S, Shinoda A, Kamatsuka E, So K, Kinjo T, Sasaki T, Ito K, Kudoh Y, Sato K, Endo H, Shimizu H, Karibe H, Byouin F, Takahashi K, Nakajima M, Watanabe K, Nozaki K, Takayama M, Komuro T, Hirai H, Suzuki F, Suzuki H, Murata H, Miya F, Kanamaru K, Tamura A, Harada K, Fukazawa S, Takehara S, Watanabe Y, Nakayama T, Sato H, Nagura H, Amano S, Tanoi C, Kuroda K, Morooka S, Wataya T, Kitagawa M, Koide K, Tanigawara T, Iwama T, Ito J, Noda S, Kohno K, Kitazawa K, Kusano Y, Takemae T, Hokama M, Sato H, Nishiyama Y, Seguchi T, Kobayashi S, Inui Y, Ohigashi Y, Muraoka S, Miyatake M, Hayashida K, Nakagawa S, Inoue A, Sakai K, Yamaguchi S, Mizoue T, Ikawa F, Ishida G, Irie H, Kagawa T, Namba Y, Nakashima H, Tokunaga K, Date I, Abe K, Uno M, Chin M, Yamagata S, Sasayama H, Takao S, Yoshida H, Muneda K, Watanebe A, Harada K, Kato S, Hamada Y, Suzuki M, Nishizaki T, Yamashita K, Nakamura T, Wakabayashi S, Okazaki T, Kurisu K, Matsumoto M, Hosomi N, Tominaga A, Kiya K, Shibukawa M, Oki S, Nakahara T, Okita S, Torii T, Nakagawa M, Fujiwara K, Matsuoka T, Nishimura S, Hamasaki O, Isobe N, Satomi J, Nagahiro S, Agawa M, Oka H, Yoshimura K, Haga S, Asaoka K, Nakamura T, Kato T, Kobayasi N, Minoshima S, Mikuni N, Niwa J, Tanikawa R, Yamamura A, Watabe N, Sasaki J, Otawara Y, Miura K, Tominaga T, Sasaki T, Sugawara T, Ezura M, Ishikawa S, Takemura S, Kawakami M, Ihara S, Shibata Y, Saegusa T, Iuchi T, Ito C, Isimaru S, Okuda O, Yoshida K, Akiyama T, Suga S, Katayama M, Kasai M, Oikawa A, Miura N, Ota T, Takenobu A, Kumabe T, Suzuki S, Kumagai T, Nishimaki K, Hongo K, Shigeta H, Sato A, Kuroda S, Higashi S, Oyama H, Hattori K, Uozumi Y, Nakahara N, Hashimoto N, Ichihashi T, Takenaka K, Nonaka Y, Shirakami S, Imai S, Okumura Y, Tamaki R, Yokoyama K, Miyamoto S, Akiyama Y, Hashimoto K, Yamamoto K, Ichioka T, Nakazawa K, Nishikawa M, Inoue T, Kinoshita M, Yoshimura S, Saitoh M, Aihara H, Miyake H, Ogihara K, Nishiura T, Nishino S, Miyoshi Y, Arisawa T, Daido S, Tsuchimoto S, Kinoshita K, Yuki K, Migita K, Akatsuka K, Fujisawa H, Yamamoto J, Inoha S, Takaba H, Shono T, Tsugu H, Hayashi S, Abe T, Nakashima S, Tuji T, Yamamoto K, Kaga A, Kanemaru R, Takasaki K, Imamura J, Noha M, Watanabe S, Sakai N, Yoshida Y, Minami H, Okumura T, Nishimura S, Numazawa S, Niimi Y, Kazekawa K, Tsutsumi M, Fukuyama K, Ichinose M, Fujimoto Y, Hashimoto Y, Matsuoka T, Uchizawa T, Sato T, Sawaura H, Utsuki S, Takahashi C, Yamatani K, Tsukada T, Hayashi R, Kitahara M, Kakizawa Y, Yamamoto Y, Yoshida T, Goto Y, Tominaga T, Miyake S, Mori N, Shinohara N, Ejima Y, Mori M, Miyake H, Koga H, Matsumoto K, Morimoto K, Niiya Y, Shishido T, Murakami M, Yoshida T, Hara M, Nakamura T, Kawai T, Inoue T, Sasaki I, Fujimura N.

Abstract

OBJECTIVES:

This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)-associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database.

METHODS:

We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC- and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge.

RESULTS:

DOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039).

CONCLUSIONS:

This nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.

PMID:
29490916
PMCID:
PMC5880631
DOI:
10.1212/WNL.0000000000005207
[Indexed for MEDLINE]
Free PMC Article

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