Outcome of intracerebral haemorrhage related to non-vitamin K antagonists oral anticoagulants versus vitamin K antagonists: a comprehensive systematic review and meta-analysis

Abstract

Our results confirm that ICH volume, haematoma expansion, mortality and functional outcome appear to be similar for NOAC-ICH versus VKA-ICH. Large prospective cohorts and updated meta-analyses are needed to provide more precise estimates.

Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

“…12 A systematic review and meta-analysis of 12 studies published in 2018 including 393 NOAC-ICH and 3482 VKA-ICH reported similar results, 13 as did another recent prospective study including 62 NOAC-ICH and 134 VKA-ICH. 12 A systematic review and meta-analysis of 12 studies published in 2018 including 393 NOAC-ICH and 3482 VKA-ICH reported similar results, 13 as did another recent prospective study including 62 NOAC-ICH and 134 VKA-ICH.…”

“…A recent international multicenter retrospective study found no difference in 3-month all-cause mortality or functional outcome between NOAC-ICH (n = 97) and VKA-ICH (n = 403). 12 A systematic review and meta-analysis of 12 studies published in 2018 including 393 NOAC-ICH and 3482 VKA-ICH reported similar results, 13 as did another recent prospective study including 62 NOAC-ICH and 134 VKA-ICH. 14 Tsivgoulis et al (Ann Neurol.…”

“…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.…”

“…No significant difference was found in 90-day estimated functional outcome between NOAC-and VKA-ICH (P = 0.52). Following NOAC-ICH, 13.7% (n = 41) were functionally independent (mRS 0-2) at 90 days, whereas 27.3% (n = 82) were dependent (mRS 3-5), and 44.3%…”

Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage

“…We also consider that the results from the current IPDM, incorporating data from international multicenter cohorts, are likely to be more easily generalizable to every clinical setting. 37 The finding of lower baseline hematoma volumes in NOAC-ICH compared to VKA-ICH could be attributed to the more favorable pharmacological properties of NOACs, including shorter plasma half-life and selective inhibition of the extrinsic coagulation pathway, compared to VKAs. 36 A nonsignificant association for lower baseline ICH volume in NOAC-ICH compared to VKA-ICH was also reported in this meta-analysis (standardized mean difference = −0.24, 95% CI −0.52 to 0.04, p = 0.093), whereas the association of NOAC-related ICH with 30-day mortality was not evaluated in this meta-analysis.…”