Intracerebral hemorrhage associated with warfarin versus non-vitamin K antagonist oral anticoagulants in Asian patients

Woo, Ho Geol; Chung, Inyoung; Gwak, Dong Seok; Kim, Baik Kyun; Kang, Jihoon; Kim, Beom Joon; Bae, Hee Joon; Han, Moon Ku

doi:10.1016/j.jocn.2018.10.102

Cited by 12 publications

(9 citation statements)

References 44 publications

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“…The current US and European guidelines recommend FXa inhibitors and direct thrombin inhibitor over warfarin for stroke prevention in high-risk patients with atrial fibrillation. 13,14 FXa 8,15,16 Importantly, in certain clinical scenarios, such as atrial fibrillation with recent percutaneous coronary intervention, patients may be required to take both anticoagulant and antiplatelet agents for secondary prevention. Once bleeding complications occurred, however, we found that patients with warfarin-associated ICH had worse outcomes with both single-antiplatelet and dual-antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Although the exact reason for better outcomes for FXa inhibitor–associated ICH vs warfarin-associated ICH remains unknown, we observed less severe stroke at presentation as measured by the NIHSS score in patients with FXa inhibitor–associated ICH. Although the differences in stroke severity may be explained by the underlying risk profiles between patients receiving FXa inhibitor and warfarin, previous studies have suggested smaller ICH volume, less hematoma expansion, and fewer concomitant intraventricular hemorrhage in patients with ICH taking non–vitamin K OACs . Importantly, in certain clinical scenarios, such as atrial fibrillation with recent percutaneous coronary intervention, patients may be required to take both anticoagulant and antiplatelet agents for secondary prevention.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage

et al. 2021

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Key Points Question What is the association between prior oral anticoagulant use (factor Xa [FXa] inhibitors, warfarin, or none) and in-hospital outcomes among patients with nontraumatic intracerebral hemorrhage (ICH)? Findings In this registry-based cohort study of 219 701 patients with ICH, prior use of FXa inhibitors was associated with higher in-hospital mortality vs no prior anticoagulant use, although FXa inhibitors were associated with lower in-hospital mortality than warfarin. Meaning These findings suggest that patients with FXa inhibitor–associated ICH have a higher risk of mortality than those not taking an oral anticoagulant but better outcomes than those with warfarin-related ICH.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage

et al. 2021

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“…Different from warfarin, novel oral anticoagulants (NOACs) are lower risk and are excellent in preventing stroke and limiting haemorrhage especially intracranial haemorrhage [7, 8]. Moreover, a recent meta-analysis has suggested that NOACs are more effective and safer among Asian patients than non-Asians in terms of complications such as stroke or systemic embolism (SSE) and major bleeding [9], which indicates that Asian patients would largely benefit from the development of NOACs.…”

Section: Introductionmentioning

confidence: 99%

Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis

Zhang

Tang

Cui

et al. 2019

BMC Cardiovasc Disord

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Background The development of novel oral anticoagulants (NOACs) has changed the landscape of non-valvular atrial fibrillation (NVAF) management. In this study, the effectiveness and the safety of several NOACs were evaluated in a real-world setting among Asian patients with NVAF. Methods The literature search was conducted crossing different databases including Embase, MEDLINE, and the Cochrane Library from inception through March 1, 2019, for studies which included real-world perspectives comparing the individual NOACs with each other or with warfarin among Asians with NVAF. The primary outcomes were defined as stroke or systemic embolism (SSE) and major bleeding; ischemic stroke, all-cause death as well as intracranial bleeding were classified as the secondary outcomes. Results From sixteen real-world studies, a total of 312,827 Asian patients were included in this analysis. In comparison with warfarin, the utilization of apixaban, dabigatran, and rivaroxaban significantly lowered the risk of major bleeding (apixaban: HR 0.47, 95%CI 0.35–0.63; dabigatran: HR 0.59, 95%CI 0.47–0.73; rivaroxaban: HR 0.66, 95%CI 0.52–0.83) and lessened the all-cause death rate (apixaban: HR 0.29, 95%CI 0.16–0.52; dabigatran: HR 0.40, 95%CI 0.27–0.60; rivaroxaban: HR 0.42, 95%CI 0.28–0.65). Apixaban (HR 0.59; 95%CI 0.40–0.85) reduced the possibility of ischemic stroke when compared against dabigatran. Rivaroxaban showed a higher chance of causing an ischemic stroke (HR 1.61; 95%CI 1.08–2.41) and major bleeding (HR 1.39; 95%CI 1.02–1.90) than Apixaban. Conclusions Apixaban, dabigatran and rivaroxaban were more effective than warfarin on reducing the risks of stroke and haemorrhage; meanwhile, apixaban was likely to lower the risk of major bleeding comparing to rivaroxaban. Trial registration PROSPERO registry number: CRD42018086914 . Electronic supplementary material The online version of this article (10.1186/s12872-019-1165-5) contains supplementary material, which is available to authorized users.

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“…Rivaroxaban significantly reduces blood–brain barrier permeability, and compared with warfarin, it results in less hemorrhage and hematoma volume (Sawada et al, 2017) with a better survival rate from hemorrhagic stroke in mice (Petrault et al, 2019; Sawada et al, 2017). In humans, intracranial hemorrhage volume is also significantly less with NOACs than with warfarin (Kawabori et al, 2018; Woo et al, 2019). Neurological outcomes are also better with NOACs than with warfarin (Kawabori et al, 2018; Lioutas et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Predictors of hemorrhagic stroke in older persons taking nonsteroidal anti-inflammatory drugs: Results from the Food and Drug Administration Adverse Event Reporting System

McDonald

Srisopa

2020

J Am Assoc Nurse Pract

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Background: Hemorrhagic strokes have not declined in the United States despite a decline worldwide. Purpose: To identify hemorrhagic stroke risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs), other medications associated with increased risk for hemorrhagic stroke, and diabetes, cardiovascular disease, gender, and age. Methods: A post hoc design was used to examine predictors of hemorrhagic stroke for adults of age 65 years and older from the Food and Drug Administration Adverse Events Reporting System database. The initial sample consisted of all cases reported during the third quarter of 2016 and the second quarter of 2018 with an NSAID as the primary suspect for the adverse drug event (ADE). An additional 397 cases with warfarin as the primary suspect were included in the final sample (N = 3,784) to test for bias from including only NSAID as the primary ADE suspect cases. Extracted data included the primary ADE (hemorrhagic stroke or other ADE), age, gender, primary suspect drug (NSAID or warfarin), and presence of a second NSAID, rivaroxaban, warfarin, clopidogrel, antidepressants (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants), inhaled corticosteroids, diabetes, or cardiovascular medications. Logistic regression was used to predict hemorrhagic stroke. Results: Aspirin and warfarin increased the risk for hemorrhagic stroke by 3.458 and 3.059, respectively. Presence of an additional NSAIDs reduced the risk by 48%. Implications for practice: Hemorrhagic stroke risk specific to older adults may provide helpful estimates for practitioners as they weigh the risk benefit of prescribing aspirin as an antiplatelet therapy for older adults.

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Intracerebral hemorrhage associated with warfarin versus non-vitamin K antagonist oral anticoagulants in Asian patients

Cited by 12 publications

References 44 publications

Clinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage

Clinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage

Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis

Predictors of hemorrhagic stroke in older persons taking nonsteroidal anti-inflammatory drugs: Results from the Food and Drug Administration Adverse Event Reporting System

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