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Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage

Annals of neurology, Vol: 84, Issue: 5, Page: 694-704
2018
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Article Description

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 < 30cmINTERPRETATION: 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.

Bibliographic Details

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

Wiley-Liss

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