Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage

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‐analys...

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Published in:Annals of neurology 2018-11, Vol.84 (5), p.694-704
Main Authors: Tsivgoulis, Georgios, Wilson, Duncan, Katsanos, Aristeidis H., Sargento‐Freitas, João, Marques‐Matos, Cláudia, Azevedo, Elsa, Adachi, Tomohide, 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, Salman, Rustam Al‐Shahi, Jäger, Hans R., Shakeshaft, Clare, Yakushiji, Yusuke, Choi, Philip M. C., Staals, Julie, Cordonnier, Charlotte, Jeng, Jiann‐Shing, Veltkamp, Roland, Dowlatshahi, Dar, Engelter, Stefan T., Parry‐Jones, Adrian R., Meretoja, Atte, Mitsias, Panayiotis D., Alexandrov, Andrei V., Ambler, Gareth, Werring, David J.
Format: Article
Language:English
Subjects:
Administration, Oral
Adult
Aged
Aged, 80 and over
Antagonists
Anticoagulants
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Cerebral Hemorrhage - chemically induced
Cerebral Hemorrhage - mortality
Cerebral Hemorrhage - pathology
Clinical outcomes
Confidence intervals
Data processing
Discharge
Female
Females
Hematoma
Hemorrhage
Humans
Male
Medical imaging
Middle Aged
Mortality
Neuroimaging
Neurology
Patients
Regression analysis
Regression coefficients
Statistical analysis
Stroke
Vitamin K
Vitamin K - antagonists & inhibitors
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Summary: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 
ISSN:0364-5134
1531-8249
DOI:10.1002/ana.25342