Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage

Tsivgoulis, Georgios; Wilson, Duncan; Katsanos, Aristeidis H.; Sargento-Freitas, João; Marques-Matos, Cláudia; Azevedo, Elsa; Adachi, Tomohide; Brelie, Christian von der; Aizawa, Yoshifusa; Abe, Hiroshi; Tomita, Hirofumi; Okumura, Ken; Hagii, Joji; Seiffge, David J; Lioutas, Vasileios; Traenka, Christopher; Varelas, Panayiotis N.; Basir, Ghazala; Krogias, Christos; Purrucker, Jan; Sharma, Vijay K.; Rizos, Timolaos; Mikulík, Robert; Sobowale, Oluwaseun; Barlinn, Kristian; Sallinen, Hanne; Goyal, Nitin; Yeh, Shin-Joe; Karapanayiotides, Theodoros; Wu, Teddy Y; Vadikolias, Κonstantinos; Ferré, Marc; Hadjigeorgiou, Georgios M.; Houben, Rik; Giannopoulos, Sotirios; Schreuder, Floris H.B.M.; Chang, Jason J.; Perry, Luke A; Mehdorn, Maximilian; Marto, João Pedro; Pinho, João; Tanaka, Jun; Boulanger, Marion; Salman, Rustam Al-Shahi; Jäger, Hans Rolf; Shakeshaft, Clare; Yakushiji, Yusuke; Choi, Philip; Staals, Julie; Cordonnier, Charlotte; Jeng, Jiann‐Shing; Veltkamp, Roland; Dowlatshahi, Dar; Engelter, Stefan T.; Parry‐Jones, Adrian; Meretoja, Atte; Mitsias, Panayiotis; Alexandrov, Andrei V.; Ambler, Gareth; Werring, David J.

doi:10.1002/ana.25342

Cited by 45 publications

(39 citation statements)

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“…We found no significant difference in 90-day functional outcome or mortality following VKA-and NOAC-ICH, which is consistent with some previous studies. 12,13,15,30,31 In unadjusted analyses, a non-significant trend of superior survival after VKA-ICH was seen (HR = 1.06; VKA reference). However, after adjusting for confounders, a reversed trend was observed (HR = 0.93).…”

Section: Discussionmentioning

confidence: 99%

“…12,13,15,30,31 In unadjusted analyses, a non-significant trend of superior survival after VKA-ICH was seen for reversal of two other NOACs (apixaban and rivaroxaban) was approved in the USA. We found no significant difference in 90-day functional outcome or mortality following VKA-and NOAC-ICH, which is consistent with some previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…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: 98%

“…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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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: 99%

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confidence: 99%

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confidence: 98%

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confidence: 98%

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Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

et al. 2019

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“…Therefore, it still remains unclear whether the difference in incident stroke severity between NOAC and warfarin groups is associated with the cerebrovascular ischaemic or bleeding events or both. Observational study data suggest that patients with ICH under NOAC treatment tend to present with smaller hematoma volumes and less severe syndromes compared with patients with ICH under treatment with vitamin K antagonists (VKAs) . Likewise, existing observational evidence also suggests milder stroke severity and smaller infarct sizes for acute ischaemic stroke patients on NOAC treatment compared with those on treatment with VKAs .…”

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Is decreased stroke severity in patients with atrial fibrillation receiving non‐vitamin K oral anticoagulant treatment the coup de grâce for warfarin?

Katsanos

2020

Euro J of Neurology

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Stroke Therapeutics in the Care of Older Persons

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Kirkham

et al. 2023

Practical Issues in Geriatrics

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Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage

Abstract: Additional supporting information may be found online in the Supporting Information section at the end of the article.

Cited by 45 publications

References 51 publications

Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

Is decreased stroke severity in patients with atrial fibrillation receiving non‐vitamin K oral anticoagulant treatment the coup de grâce for warfarin?

Stroke Therapeutics in the Care of Older Persons

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