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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; von der Brelie, Christian; Aizawa, Yoshifusa; Abe, Hiroshi; Tomita, Hirofumi; Okumura, Ken; Hagii, Joji; Seiffge, David J; Lioutas, Vasileios-Arsenios; Traenka, Christopher; Varelas, Panayiotis; Basir, Ghazala; Krogias, Christos; Purrucker, Jan C; Sharma, Vijay K; Rizos, Timolaos; Mikulik, Robert; Sobowale, Oluwaseun A; Barlinn, Kristian; Sallinen, Hanne; Goyal, Nitin; Yeh, Shin-Joe; Karapanayiotides, Theodore; Wu, Teddy Y; Vadikolias, Konstantinos; Ferrigno, Marc; Hadjigeorgiou, Georgios; 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; Al-Shahi Salman, Rustam; Jäger, Hans R; Shakeshaft, Clare; Yakushiji, Yusuke; Choi, Philip M C; Staals, Julie; Cordonnier, Charlotte.
Affiliation
  • Tsivgoulis G; Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Wilson D; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
  • Katsanos AH; Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom, New Zealand Brain Research Institute, Christchurch, New Zealand.
  • Sargento-Freitas J; Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Marques-Matos C; Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.
  • Azevedo E; Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
  • Adachi T; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
  • von der Brelie C; Department of Neurology, São João University Hospital Center, Porto, Portugal.
  • Aizawa Y; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
  • Abe H; Department of Neurology, São João University Hospital Center, Porto, Portugal.
  • Tomita H; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
  • Okumura K; Department of Neurology and General Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
  • Hagii J; Department of Neurosurgery, Georg August University of Göttingen, Göttingen, Germany.
  • Seiffge DJ; Department of Research and Development, Tachikawa Medical Center, Nagaoka, Japan.
  • Lioutas VA; Department of Research and Development, Tachikawa Medical Center, Nagaoka, Japan.
  • Traenka C; Department of Cardiology and Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
  • Varelas P; Advanced Arrhythmia Therapeutic Branch, Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
  • Basir G; Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
  • Krogias C; Stroke Center and Neurology, University Hospital and University of Basel, Basel, Switzerland.
  • Purrucker JC; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
  • Sharma VK; Stroke Center and Neurology, University Hospital and University of Basel, Basel, Switzerland.
  • Rizos T; Department of Neurology, Henry Ford Hospital, Detroit, MI.
  • Mikulik R; Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
  • Sobowale OA; Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany.
  • Barlinn K; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
  • Sallinen H; Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Goyal N; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
  • Yeh SJ; International Clinical Research Center and Neurology Department, St Anne's Hospital and Masaryk University, Brno, Czech Republic.
  • Karapanayiotides T; Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
  • Wu TY; Department of Neurology, Dresden Neurovascular Center, Dresden, Germany.
  • Vadikolias K; Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
  • Ferrigno M; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
  • Hadjigeorgiou G; Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan.
  • Houben R; Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
  • Giannopoulos S; Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
  • Schreuder FHBM; Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece.
  • Chang JJ; Department of Neurology, Lille University, INSERM U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Lille, France.
  • Perry LA; Department of Neurology, University of Thessaly, Larissa, Greece.
  • Mehdorn M; Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
  • Marto JP; Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.
  • Pinho J; Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
  • Tanaka J; Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
  • Boulanger M; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
  • Al-Shahi Salman R; Department of Neurosciences, Eastern Health, Melbourne, Victoria, Australia.
  • Jäger HR; Department of Neurosurgery, Georg August University of Göttingen, Göttingen, Germany.
  • Shakeshaft C; Neurology Department, Egas Moniz Hospital, West Lisbon Hospital Center, Lisbon, Portugal.
  • Yakushiji Y; CEDOC, Nova Medical School, New University of Lisbon, Lisbon, Portugal.
  • Choi PMC; Department of Neurology, Braga Hospital, Braga, Portugal.
  • Staals J; Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
  • Cordonnier C; Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom.
Ann Neurol ; 84(5): 694-704, 2018 11.
Article in En | MEDLINE | ID: mdl-30255970
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;84702-712.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cerebral Hemorrhage / Anticoagulants Type of study: Observational_studies / Risk_factors_studies / Systematic_reviews Limits: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Journal: Ann Neurol Year: 2018 Type: Article Affiliation country: Greece
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cerebral Hemorrhage / Anticoagulants Type of study: Observational_studies / Risk_factors_studies / Systematic_reviews Limits: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Journal: Ann Neurol Year: 2018 Type: Article Affiliation country: Greece