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Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage

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Tsivgoulis G., Wilson D., Katsanos A.H., Sargento-Freitas J., Marques-Matos C., Azevedo E., Adachi T., von der Brelie C., Aizawa Y., Abe H., Tomita H., Okumura K., Hagii J., Seiffge D.J., Lioutas V.-A., Traenka C., Varelas P., Basir G., Krogias C., Purrucker J.C., Sharma V.K., Rizos T., Mikulik R., Sobowale O.A., Barlinn K., Sallinen H., Goyal N., Yeh S.-J., Karapanayiotides T., Wu T.Y., Vadikolias K., Ferrigno M., Hadjigeorgiou G., Houben R., Giannopoulos S., Schreuder F.H.B.M., Chang J.J., Perry L.A., Mehdorn M., Marto J.-P., Pinho J., Tanaka J., Boulanger M., Salman R.A.-S., Jäger H.R., Shakeshaft C., Yakushiji Y., Choi P.M.C., Staals J., Cordonnier C., Jeng J.-S., Veltkamp R., Dowlatshahi D., Engelter S.T., Parry-Jones A.R., Meretoja A., Mitsias P.D., Alexandrov A.V., Ambler G., Werring D.J.
Date
2018
Language
en
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Abstract
Objective: Whether intracerebral hemorrhage (ICH) associated with non–vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. Methods: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. Results: We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs 26.5%; hazard ratio = 0.94, 95% confidence interval [CI] = 0.67–1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = −2.83, 95% CI = −5.28 to −0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30–0.84), and smaller baseline hematoma volume (linear regression coefficient = −0.24, 95% CI = −0.47 to −0.16). The two groups did not differ in the likelihood of baseline hematoma volume < 30cm3 (OR = 1.14, 95% CI = 0.81–1.62), hematoma expansion (OR = 0.97, 95% CI = 0.63–1.48), in-hospital mortality (OR = 0.73, 95% CI = 0.49–1.11), functional status at discharge (common OR = 0.78, 95% CI = 0.57–1.07), or functional status at 3 months (common OR = 1.03, 95% CI = 0.75–1.43). Interpretation: Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702–712. © 2018 American Neurological Association
URI
http://hdl.handle.net/11615/80071
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