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Characteristics in Non-Vitamin K Antagonist Oral Anticoagulant-Related Intracerebral Hemorrhage.
Gerner, Stefan T; Kuramatsu, Joji B; Sembill, Jochen A; Sprügel, Maximilian I; Hagen, Manuel; Knappe, Ruben U; Endres, Matthias; Haeusler, Karl Georg; Sobesky, Jan; Schurig, Johannes; Zweynert, Sarah; Bauer, Miriam; Vajkoczy, Peter; Ringleb, Peter A; Purrucker, Jan C; Rizos, Timolaos; Volkmann, Jens; Müllges, Wolfgang; Kraft, Peter; Schubert, Anna-Lena; Erbguth, Frank; Nueckel, Martin; Schellinger, Peter D; Glahn, Jörg; Knappe, Ulrich J; Fink, Gereon R; Dohmen, Christian; Stetefeld, Henning; Fisse, Anna Lena; Minnerup, Jens; Hagemann, Georg; Rakers, Florian; Reichmann, Heinz; Schneider, Hauke; Rahmig, Jan; Ludolph, Albert Christian; Stösser, Sebastian; Neugebauer, Hermann; Röther, Joachim; Michels, Peter; Schwarz, Michael; Reimann, Gernot; Bäzner, Hansjörg; Schwert, Henning; Claßen, Joseph; Michalski, Dominik; Grau, Armin; Palm, Frederick; Urbanek, Christian; Wöhrle, Johannes C.
Afiliación
  • Gerner ST; From the Department of Neurology (S.T.G., J.B.K., J.A.S., M.I.S., M. Hagen, R.U.K., S. Schwab, H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Kuramatsu JB; From the Department of Neurology (S.T.G., J.B.K., J.A.S., M.I.S., M. Hagen, R.U.K., S. Schwab, H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Sembill JA; From the Department of Neurology (S.T.G., J.B.K., J.A.S., M.I.S., M. Hagen, R.U.K., S. Schwab, H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Sprügel MI; From the Department of Neurology (S.T.G., J.B.K., J.A.S., M.I.S., M. Hagen, R.U.K., S. Schwab, H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Hagen M; From the Department of Neurology (S.T.G., J.B.K., J.A.S., M.I.S., M. Hagen, R.U.K., S. Schwab, H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Knappe RU; From the Department of Neurology (S.T.G., J.B.K., J.A.S., M.I.S., M. Hagen, R.U.K., S. Schwab, H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Endres M; Department of Neurology (M.E., K.G.H., J. Sobesky, S.Z.), Charité-Universitätsmedizin Berlin, Germany.
  • Haeusler KG; Center for Stroke Research Berlin, Berlin, Germany (M.E., K.G.H., J. Sobesky, J. Schurig, M.B.).
  • Sobesky J; German Centre for Cardiovascular Research (DZHK), Oudenarder Straße, Berlin (M.E.).
  • Schurig J; German Center for Neurodegenerative Diseases (DZNE), partner site Berlin (M.E.).
  • Zweynert S; Department of Neurology (M.E., K.G.H., J. Sobesky, S.Z.), Charité-Universitätsmedizin Berlin, Germany.
  • Bauer M; Center for Stroke Research Berlin, Berlin, Germany (M.E., K.G.H., J. Sobesky, J. Schurig, M.B.).
  • Vajkoczy P; Department of Neurology, University of Würzburg, Germany (K.G.H., J.V., W.M., P.K., A.-L.S.).
  • Ringleb PA; Department of Neurology (M.E., K.G.H., J. Sobesky, S.Z.), Charité-Universitätsmedizin Berlin, Germany.
  • Purrucker JC; Center for Stroke Research Berlin, Berlin, Germany (M.E., K.G.H., J. Sobesky, J. Schurig, M.B.).
  • Rizos T; Center for Stroke Research Berlin, Berlin, Germany (M.E., K.G.H., J. Sobesky, J. Schurig, M.B.).
  • Volkmann J; Department of Neurology (M.E., K.G.H., J. Sobesky, S.Z.), Charité-Universitätsmedizin Berlin, Germany.
  • Müllges W; Center for Stroke Research Berlin, Berlin, Germany (M.E., K.G.H., J. Sobesky, J. Schurig, M.B.).
  • Kraft P; Department of Neurosurgery (P.V.), Charité-Universitätsmedizin Berlin, Germany.
  • Schubert AL; Department of Neurology, Heidelberg University Hospital, Germany (P.A.R., J.C.B., T.R.).
  • Erbguth F; Department of Neurology, Heidelberg University Hospital, Germany (P.A.R., J.C.B., T.R.).
  • Nueckel M; Department of Neurology, Heidelberg University Hospital, Germany (P.A.R., J.C.B., T.R.).
  • Schellinger PD; Department of Neurology, University of Würzburg, Germany (K.G.H., J.V., W.M., P.K., A.-L.S.).
  • Glahn J; Department of Neurology, University of Würzburg, Germany (K.G.H., J.V., W.M., P.K., A.-L.S.).
  • Knappe UJ; Department of Neurology, University of Würzburg, Germany (K.G.H., J.V., W.M., P.K., A.-L.S.).
  • Fink GR; Department of Neurology, University of Würzburg, Germany (K.G.H., J.V., W.M., P.K., A.-L.S.).
  • Dohmen C; Department of Neurology, Community Hospital Nuremberg, Germany (F.E., M.N.).
  • Stetefeld H; Department of Neurology, Community Hospital Nuremberg, Germany (F.E., M.N.).
  • Fisse AL; Department of Neurology and Neurogeriatry (P.D.S., J.G.).
  • Minnerup J; Department of Neurology and Neurogeriatry (P.D.S., J.G.).
  • Hagemann G; Department of Neurosurgery, Johannes Wesling Medical Center Minden, University Clinic Ruhr University Bochum, Germany (U.J.K.).
  • Rakers F; Department of Neurology, University of Cologne, Germany (G.R.F. C.D., H. Stetefeld).
  • Reichmann H; Department of Neurology, University of Cologne, Germany (G.R.F. C.D., H. Stetefeld).
  • Schneider H; Department of Neurology, LVR Klinik Bonn, Germany (C.D.).
  • Rahmig J; Department of Neurology, University of Cologne, Germany (G.R.F. C.D., H. Stetefeld).
  • Ludolph AC; Department of Neurology, University of Münster, Germany (A.L.F., J.M.).
  • Stösser S; Department of Neurology, University of Münster, Germany (A.L.F., J.M.).
  • Neugebauer H; Department of Neurology, Community Hospital Helios Klinikum Berlin-Buch, Germany (G.H., F.R.).
  • Röther J; Department of Neurology, Community Hospital Helios Klinikum Berlin-Buch, Germany (G.H., F.R.).
  • Michels P; Department of Neurology, University of Dresden, Germany (H.R., H. Schneider, J. Rahmig).
  • Schwarz M; Department of Neurology, Klinikum Augsburg, Germany (H. Schneider).
  • Reimann G; Department of Neurology, University of Dresden, Germany (H.R., H. Schneider, J. Rahmig).
  • Bäzner H; Department of Neurology, University of Dresden, Germany (H.R., H. Schneider, J. Rahmig).
  • Schwert H; Department of Neurology, University of Ulm, Germany (A.C.L., S. Stösser, H.N.).
  • Claßen J; Department of Neurology, University of Ulm, Germany (A.C.L., S. Stösser, H.N.).
  • Michalski D; Department of Neurology, University of Ulm, Germany (A.C.L., S. Stösser, H.N.).
  • Grau A; Department of Neurology, Community Hospital Asklepios Klinik Hamburg Altona, Germany (J. Röther, P.M.).
  • Palm F; Department of Neurology, Community Hospital Asklepios Klinik Hamburg Altona, Germany (J. Röther, P.M.).
  • Urbanek C; Department of Neurology, Community Hospital Klinikum Dortmund, Germany (M.S., G.R.).
  • Wöhrle JC; Department of Neurology, Community Hospital Klinikum Dortmund, Germany (M.S., G.R.).
Stroke ; 50(6): 1392-1402, 2019 06.
Article en En | MEDLINE | ID: mdl-31092170
Background and Purpose- Given inconclusive studies, it is debated whether clinical and imaging characteristics, as well as functional outcome, differ among patients with intracerebral hemorrhage (ICH) related to vitamin K antagonists (VKA) versus non-vitamin K antagonist (NOAC)-related ICH. Notably, clinical characteristics according to different NOAC agents and dosages are not established. Methods- Multicenter observational cohort study integrating individual patient data of 1328 patients with oral anticoagulation-associated ICH, including 190 NOAC-related ICH patients, recruited from 2011 to 2015 at 19 tertiary centers across Germany. Imaging, clinical characteristics, and 3-months modified Rankin Scale (mRS) outcomes were compared in NOAC- versus VKA-related ICH patients. Propensity score matching was conducted to adjust for clinically relevant differences in baseline parameters. Subgroup analyses were performed regarding NOAC agent, dosing and present clinically relevant anticoagulatory activity (last intake <12h/24h or NOAC level >30 ng/mL). Results- Despite older age in NOAC patients, there were no relevant differences in clinical and hematoma characteristics between NOAC- and VKA-related ICH regarding baseline hematoma volume (median [interquartile range]: NOAC, 14.7 [5.1-42.3] mL versus VKA, 16.4 [5.8-40.6] mL; P=0.33), rate of hematoma expansion (NOAC, 49/146 [33.6%] versus VKA, 235/688 [34.2%]; P=0.89), and the proportion of patients with unfavorable outcome at 3 months (mRS, 4-6: NOAC 126/179 [70.4%] versus VKA 473/682 [69.4%]; P=0.79). Subgroup analyses revealed that NOAC patients with clinically relevant anticoagulatory effect had higher rates of intraventricular hemorrhage (n/N [%]: present 52/109 [47.7%] versus absent 9/35 [25.7%]; P=0.022) and hematoma expansion (present 35/90 [38.9%] versus absent 5/30 [16.7%]; P=0.040), whereas type of NOAC agent or different NOAC-dosing regimens did not result in relevant differences in imaging characteristics or outcome. Conclusions- If effectively anticoagulated, there are no differences in hematoma characteristics and functional outcome among patients with NOAC- or VKA-related ICH. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT03093233.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Vitamina K / Hemorragia Cerebral / Fibrinolíticos / Anticoagulantes Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Stroke Año: 2019 Tipo del documento: Article País de afiliación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Vitamina K / Hemorragia Cerebral / Fibrinolíticos / Anticoagulantes Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Stroke Año: 2019 Tipo del documento: Article País de afiliación: Alemania