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OBJECTIVE: Patients receiving treatment with oral anticoagulants (OACs) are at risk of intracranial hemorrhage (ICH). In this study, we describe the epidemiological and clinical characteristics of patients receiving OACs who experience ICH and compare those receiving vitamin K antagonists (ICH-VKAs) with those receiving direct OACs (ICH-DOACs). METHODS: We performed a national, multicenter, descriptive, observational, retrospective study of all adult patients receiving OACs who were admitted to the neurology department with ICH over a 1-year period. The study population was divided into 2 groups (ICH-VKAs and ICH-DOACs). Epidemiological, clinical, radiological, and therapy-related variables, as well as functional outcome, were compared at 3 months. A total of 366 cases were included (331 ICH-VKAs, 35 ICH- DOACs). RESULTS: The crude annual incidence of OAC-induced ICH was 3.8 (95% CI, 2.78-3.41) per 100,000 inhabitants/year. The mean (± SD) age was greater for ICH-DOACs (81.5 ± 8.3 vs. 77.7 ± 8.3 years; p = 0.012). The median (IQR) volume of the hemorrhage was lower for ICH-DOACs (11 [30.8] vs. 25 [50.7] mL; p = 0.03). The functional independence rate at 3 months (modified Rankin Scale, mRS < 3) was similar in both groups, although stroke-related mortality was greater in ICH-VKAs (40 vs. 72.7%; p = 0.02). The most frequently indicated poststroke antithrombotic therapy was DOACs (38.7%). CONCLUSION: We found that the incidence of OAC-induced ICH was greater than in previous studies. Hemorrhage volume and mortality were lower in ICH-DOACs than in ICH-VKAs. After stroke, DOACs were the most frequently indicated antithrombotic treatment.
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BACKGROUND: Vitamin K antagonist oral anticoagulants (VKA-OACs) are effective for primary and secondary prevention of embolic events. The rate of haemorrhagic neurological complications in patients admitted to neurology departments in Spain is not yet known. AIMS: We aimed to determine the clinical and epidemiological characteristics of patients with intracranial haemorrhage secondary to VKA-OACs as well as the incidence of this severe complication. METHODS: We conducted a retrospective, descriptive, multi-centre study using information from the medical records of all patients admitted to neurology departments, diagnosed with spontaneous intracranial haemorrhage, and treated with VKA-OACs within a 1-year period. We collected demographic and care data from centres, patients' medical records [demographic data, medical history, haemorrhage origin, vascular risk factors, concomitant treatment, and National Institutes of Health Stroke Scale (NIHSS) scores], and patients' outcome at 3 months [independence (modified Rankin Scale score <3) and mortality rate]. RESULTS: Twenty-one hospitals serving a population of 8,155,628 inhabitants participated in the study. The total number of cases was 235, the mean age was 78.2 (SD 9.4) years, and the baseline NIHSS score was 11.6 (SD 9.5; median 9; interquartile range 14). The VKA-OACs used were acenocoumarol in 95.3% (224 patients) and warfarin in 4.7% (11 patients). The haemorrhage origin was deep in 29.8%, lobar in 25.5%, intraventricular in 11.5%, extensive in 17.4% (>100 ml), cerebellar in 12.3%, and in the brainstem in 3.4%. The international normalised ratio was within therapeutic ranges at admission (according to indication) in 29.4% (69 patients). The global incidence (cases per 100,000 inhabitants per year) is 2.88. The in-hospital mortality rate was 40%, and 24.3% of the patients were independent at 3 months, while the mortality at 3 months was 42.6%. CONCLUSION: VKA-OAC treatment is associated with a large percentage of all cases of spontaneous intracranial haemorrhage, an event leading to high dependence and mortality rates.
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Objetivo: El delirium es la complicación neuropsiquiátrica más frecuente en pacientes con afectación grave por COVID-19. Presentamos un caso atípico, desde el punto de vista clínico y fenomenológico, y reflexionamos sobre los mecanismos etiológicos implicados. Caso clínico Varón de 55 años, médico en activo, ingresado en la unidad de hospitalización convencional, y estable clínicamente tras un ingreso en la Unidad de Cuidados Intensivos por neumonía por COVID-19 grave. Presenta un delirium atípico, con alteraciones mnésicas y de lenguaje muy significativas, que se miden psicométricamente, mientras mantiene un buen nivel atencional y de alerta. El resto de las pruebas complementarias realizadas son normales o poco concluyentes. Resultados La evolución durante el ingreso es buena y la recuperación completa al mes del alta hospitalaria. Conclusiones La presentación atípica y la evolución clínica de este cuadro de delirium permiten plantear el papel neuroinvasivo directo de la COVID-19, en este caso. (AU)
Objective: Delirium is the most frequent neuropsychiatric complication in patients with a severe condition caused by COVID-19. We present an atypical case from a clinical and phenomenological point of view, and we reflect on the involved etiological mechanisms. Clinical case 55-year-old male, active physician, first admitted into the conventional hospitalization unit and is clinically stable after being admitted into the Intensive Care Unit for pneumonia caused by severe COVID-19. He presents an atypical delirium with very significant memory and language disorders, which are measured psychometrically, while maintaining a good attention and alertness level. The rest of the complementary tests carried out are normal or not very conclusive. Results The evolution during his admission is good and the recovery complete after one month of being discharged from the hospital.ConclusionsThe atypical presentation and clinical evolution of this framework of delirium allow us to raise the question of the direct neuroinvasive role of COVID-19 in this case. (AU)