Characteristics of Symptomatic Intracerebral Hemorrhage in Patient Receiving Direct Oral Anticoagulants: Comparison with Warfarin

Kawabori, Masahito; Niiya, Yoshimasa; Iwasaki, Motoyuki; Mabuchi, Shoji; Ozaki, Hiroyuki; Matsubara, Koji; Houkin, Kiyohiro

doi:10.1016/j.jstrokecerebrovasdis.2017.12.020

Cited by 28 publications

(19 citation statements)

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“…14 Tsivgoulis et al (Ann Neurol. 15 In contrast, some studies in Japanese populations have reported superior survival in NOAC-ICH compared to VKA-ICH, [16][17][18][19] including a multicenter study with 227 patients on NOAC and 2018 on VKA. 15 In contrast, some studies in Japanese populations have reported superior survival in NOAC-ICH compared to VKA-ICH, [16][17][18][19] including a multicenter study with 227 patients on NOAC and 2018 on VKA.…”

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confidence: 97%

“…2018) recently reported no difference in 3-month functional outcome and mortality between NOAC-ICH (n = 291) and VKA-ICH (n = 831). 15 In contrast, some studies in Japanese populations have reported superior survival in NOAC-ICH compared to VKA-ICH, [16][17][18][19] including a multicenter study with 227 patients on NOAC and 2018 on VKA. 20 Furthermore, some smaller studies reported less hematoma expansion in NOAC-ICH than in VKA-ICH.…”

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confidence: 97%

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Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

et al. 2019

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Background Intracerebral hemorrhage (ICH) is the most serious adverse effect of treatment with oral anticoagulants. Prognostic data after ICH associated with non‐vitamin K antagonist oral anticoagulants (NOAC) compared to vitamin K antagonists (VKA) are sparse. We compared 90‐day survival and functional outcome following NOAC‐ICH versus VKA‐ICH using data from the Swedish Stroke Register (Riksstroke). Methods Using data from Riksstroke and the Swedish Causes of Death Register between 2012 and 2016, we compared all‐cause 90‐day mortality for patients with NOAC‐ICH versus VKA‐ICH using Kaplan‐Meier survival analysis and Log‐rank test. Cox regression, with adjustment for age, sex, previous stroke, and level of consciousness (LOC) on admission, was used to estimate hazard ratios (HR) for 90‐day mortality. Estimated functional outcome at 90 days, based on the modified Rankin Scale (mRS), was compared between VKA‐ and NOAC‐associated ICH using chi‐squared test. Results We included 2483 patients; 300 with NOAC‐ICH and 2183 with VKA‐ICH. In both groups, mean age was 79 years, and 58% were male. No significant difference between NOAC‐ICH and VKA‐ICH was found for all‐cause 90‐day mortality (44.3% NOAC‐ICH versus 42.6% VKA‐ICH; P = 0.54, HR = 0.93; 95% confidence interval (CI): 0.78‐1.12) or 90‐day estimated functional outcome (mRS 0‐2:13.7% and 15.3%; mRS 3‐5:27.3% and 28.9%, respectively (P = 0.52)). Factors predicting death were increased age (HR = 1.03; 95%CI: 1.02‐1.04) and reduced LOC (drowsy: HR = 3.48; 95%CI: 2.86‐4.23; comatose: HR = 12.27; 95%CI: 10.13‐14.87). Conclusion In this large study on anticoagulant‐associated ICH, we found no significant difference in mortality and functional outcome at 90 days between NOAC‐ICH versus VKA‐ICH.

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confidence: 97%

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Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

et al. 2019

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“…Consequently, the prognosis of FXa-I-ICH may be better than VKA-ICH and balance out the disadvantage of the lack of specific reversal agents. This is plausible as the majority of published studies within this field implies that DOAC-ICH may have smaller volumes and hence better prognoses in comparison with VKA-ICH [22][23][24].…”

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confidence: 94%

Outcome of intracranial bleeding managed with prothrombin complex concentrate in patients on direct factor Xa inhibitors or vitamin K antagonists

Bavalia

Abdoellakhan

Beenen

et al. 2020

Thrombosis Research

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Intracranial hemorrhage (ICH) is the most feared complication of anticoagulation with a high mortality and morbidity. Before registration of a specific reversal agent for factor Xa inhibitors (FXa-I), international guidelines recommended prothrombin complex concentrate (PCC), which also is the specific reversal agent for vitamin K antagonists (VKA). In two contemporary cohorts, we compared clinical outcomes between patients with FXa-I and VKA related ICH treated with PCC between 2014 and 2018. Primary outcome was effective hemostasis after 24 h, according to the International Society of Thrombosis and Hemostasis definition. Safety outcomes were defined as venous and arterial thromboembolic complications and death within 30 days. Thirty-six patients with FXa-I-ICH and 39 patients with VKA-ICH were available for analysis. Baseline characteristics were comparable between both groups, except for time from start of symptoms to presentation at the hospital. In the FXa-I-ICH cohort, 24 (73%) patients achieved effective hemostasis compared to 23 (62%) patients in the VKA-ICH cohort (crude odds ratio [OR] 1.62 [95%CI 0.59-4.48], adjusted OR 1.45 [95%CI 0.44-4.83]). Eight (24%) patients with FXa-I-ICH deceased compared to 17 (45%) patients with VKA-ICH (crude OR 0.38 [95%CI 0.14-1.24], adjusted OR 0.41 [95%CI 0.12-1.24]). In this observational cohort study, the outcome of ICH managed with PCC was similar in patients with FXa-I-ICH and in patients with VKA-ICH.

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“…In addition to the advantages of the drug, however, it has serious side effects. Previous studies suggested that the use of rivaroxaban might exacerbate intracranial hemorrhage [30] in patients with mild traumatic brain injuries and thereby might cause serious and fatal complications, such as intracerebral hematoma, intracranial hemorrhage, and nontraumatic spinal subdural hematoma [31][32][33][34].…”

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confidence: 99%

The effects of rivaroxaban, an oral anticoagulant, on human IVD primary cultures

et al. 2021

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IntroductionThe present study aimed to investigate the potential effects of rivaroxaban, an oral anticoagulant that inhibits the effects of factor Xa on intact intervertebral disc tissue cells and the extracellular matrix (ECM).Material and methodsRivaroxaban was applied to primary human cell cultures prepared from tissues of the intervertebral disc. Comparative molecular analyses were performed on non-drug-treated control group samples. Descriptive statistics were presented as the mean ± standard deviation. An analysis of variance (ANOVA) test was performed to determine whether there were significant differences in the mean across the groups. When differences across groups were observed, Tukey’s honestly significant difference (HSD) post-hoc test was used for multiple pairwise comparisons. The significance of the obtained data was determined statistically. The alpha (P) significance value was < 0.05.ResultsThe cells in the control group and in the rivaroxaban-treated group were viable, healthy, and proliferated (P < 0.05). However, the expressions of the chondroadherin gene (CHAD), cartilage oligo matrix protein (COMP), matrix metallo proteinase (MMP)-13, and MMP-19 genes were changed (P < 0.05).ConclusionsAlthough rivaroxaban does not suppress cell proliferation due to morphological, biological, and biochemical changes in the intervertebral disc tissue, it may change the expression of genes that are related to ECM maintenance.

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Characteristics of Symptomatic Intracerebral Hemorrhage in Patient Receiving Direct Oral Anticoagulants: Comparison with Warfarin

Abstract: Patients with DOAC-ICH showed smaller ICH volume and better clinical outcomes than patients with warfarin-ICH, and DOAC-ICH did not show any specific onset peak.

Cited by 28 publications

References 13 publications

Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

Outcome of intracranial bleeding managed with prothrombin complex concentrate in patients on direct factor Xa inhibitors or vitamin K antagonists

The effects of rivaroxaban, an oral anticoagulant, on human IVD primary cultures

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