Early Outcome after Intracranial Hemorrhage Related to Non-Vitamin K Oral Anticoagulants

Abstract

Background: Intracranial hemorrhage (ICH) is a serious, life-threatening, but fortunately rare complication of non-vitamin K oral anticoagulant (NOAC) therapy. There are limited data on NOAC-related ICH prognosis. Methods: All consecutive patients admitted to a single center due to acute NOAC-related ICH from September 2012 until the beginning of 2017 were included. Risk factors, type of NOAC, and location of ICH were evaluated. Risk for ischemic and bleeding events and clinical status upon admission and at discharge were evaluated using standard scales. Results: Thirty-four patients aged 77.8 ± 8.3 years with NOAC-related ICH were included. The main predisposing risk factors were age and arterial hypertension. The median CHA₂DS₂-VASc score was 3.4 and the median HAS-BLED score was 1.8. Eighteen patients were treated with rivaroxaban, 11 with dabigatran, and 5 with apixaban. Ten patients (29%) had a favorable outcome with a modified Rankin Scale score ≤2 and 13 patients (38%) died. The location of the ICH was mainly intraparenchymal and subdural. Conclusions: Our retrospective single-center study shows that the mortality rate with NOAC-related ICH is <40%, which makes it comparable to that with vitamin K antagonist-related ICH.

Dabigatran Reversal With Idarucizumab and In-Hospital Mortality in Intracranial Hemorrhage: A Systematic Review of Real-Life Data From Case Reports and Case Series

“…Sixteen studies provided individual patient data of 53 patients with ICH ( 6 – 8 , 10 , 12 , 13 , 15 – 24 ), whereas six case series reported results on, overall, 394 patients ( 1 , 2 , 5 , 9 , 11 , 14 ). Two studies ( 1 , 24 ) included patient data that have been previously reported ( 7 , 8 ). In order to avoid any duplication, in this study, we only included the data from the most recent reports ( 1 , 24 ).…”

“…A small number of patients did not allow for firm conclusions. On the other hand, a relatively high number of reported case series and case reports were published in the following years (1,2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”