TY - JOUR
T1 - Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage
AU - Tsivgoulis, Georgios
AU - Wilson, Duncan
AU - Katsanos, Aristeidis H.
AU - Sargento-Freitas, João
AU - Marques-Matos, Cláudia
AU - Azevedo, Elsa
AU - Adachi, Tomohide
AU - von der Brelie, Christian
AU - Aizawa, Yoshifusa
AU - Abe, Hiroshi
AU - Tomita, Hirofumi
AU - Okumura, Ken
AU - Hagii, Joji
AU - Seiffge, David J.
AU - Lioutas, Vasileios Arsenios
AU - Traenka, Christopher
AU - Varelas, Panayiotis
AU - Basir, Ghazala
AU - Krogias, Christos
AU - Purrucker, Jan C.
AU - Sharma, Vijay K.
AU - Rizos, Timolaos
AU - Mikulik, Robert
AU - Sobowale, Oluwaseun A.
AU - Barlinn, Kristian
AU - Sallinen, Hanne
AU - Goyal, Nitin
AU - Yeh, Shin Joe
AU - Karapanayiotides, Theodore
AU - Wu, Teddy Y.
AU - Vadikolias, Konstantinos
AU - Ferrigno, Marc
AU - Hadjigeorgiou, Georgios
AU - Houben, Rik
AU - Giannopoulos, Sotirios
AU - Schreuder, Floris H.B.M.
AU - Chang, Jason J.
AU - Perry, Luke A.
AU - Mehdorn, Maximilian
AU - Marto, João Pedro
AU - Pinho, João
AU - Tanaka, Jun
AU - Boulanger, Marion
AU - Salman, Rustam Al Shahi
AU - Jäger, Hans R.
AU - Shakeshaft, Clare
AU - Yakushiji, Yusuke
AU - Choi, Philip M.C.
AU - Staals, Julie
AU - Cordonnier, Charlotte
AU - Jeng, Jiann Shing
AU - Veltkamp, Roland
AU - Dowlatshahi, Dar
AU - Engelter, Stefan T.
AU - Parry-Jones, Adrian R.
AU - Meretoja, Atte
AU - Mitsias, Panayiotis D.
AU - Alexandrov, Andrei V.
AU - Ambler, Gareth
AU - Werring, David J.
PY - 2018/11
Y1 - 2018/11
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85055512078&partnerID=8YFLogxK
U2 - 10.1002/ana.25342
DO - 10.1002/ana.25342
M3 - Article
C2 - 30255970
AN - SCOPUS:85055512078
SN - 0364-5134
VL - 84
SP - 694
JO - Annals of neurology
JF - Annals of neurology
IS - 5
M1 - 11
ER -