@article{3125831,
    title = "Direct oral anticoagulant-vs Vitamin K antagonist-related nontraumatic intracerebral hemorrhage",
    author = "Tsivgoulis, G. and Lioutas, V.-A. and Varelas, P. and Katsanos, A.H. and Goyal, N. and Mikulik, R. and Barlinn, K. and Krogias, C. and Sharma, V.K. and Vadikolias, K. and Dardiotis, E. and Karapanayiotides, T. and Pappa, A. and Zompola, C. and Triantafyllou, S. and Kargiotis, O. and Ioakeimidis, M. and Giannopoulos, S. and Kerro, A. and Tsantes, A. and Mehta, C. and Jones, M. and Schroeder, C. and Norton, C. and Bonakis, A. and Chang, J. and Alexandrov, A.W. and Mitsias, P. and Alexandrov, A.V.",
    journal = "Functional Neurology",
    year = "2017",
    volume = "89",
    number = "11",
    pages = "1142-1151",
    publisher = "Lippincott Williams and Wilkins",
    doi = "10.1212/WNL.0000000000004362",
    keywords = "apixaban;  dabigatran;  hydroxymethylglutaryl coenzyme A reductase inhibitor;  rivaroxaban;  warfarin;  anticoagulant agent;  vitamin K group, adult;  aged;  anticoagulant therapy;  Article;  atrial fibrillation;  brain blood volume;  brain hemorrhage;  cerebrovascular accident;  CHA2DS2-VASc score;  chronic kidney failure;  clinical outcome;  controlled clinical trial;  controlled study;  cross-sectional study;  disease severity;  female;  hospital admission;  human;  major clinical study;  male;  meta analysis;  multicenter study;  National Institutes of Health Stroke Scale;  neuroimaging;  observational study;  premedication;  prevalence;  priority journal;  prospective study;  risk factor;  systematic review;  tertiary care center;  antagonists and inhibitors;  atrial fibrillation;  brain;  Cerebral Hemorrhage;  clinical trial;  comparative study;  complication;  diagnostic imaging;  drug effects;  oral drug administration;  Stroke;  treatment outcome, Administration, Oral;  Aged;  Anticoagulants;  Atrial Fibrillation;  Brain;  Cerebral Hemorrhage;  Cross-Sectional Studies;  Female;  Humans;  Male;  Observational Studies as Topic;  Prospective Studies;  Stroke;  Treatment Outcome;  Vitamin K",
    abstract = "Objective: To compare the neuroimaging profile and clinical outcomes among patients with intracerebral hemorrhage (ICH) related to use of vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF). Methods: We evaluated consecutive patients with NVAF with nontraumatic, anticoagulantrelated ICH admitted at 13 tertiary stroke care centers over a 12-month period. We also performed a systematic review and meta-analysis of eligible observational studies reporting baseline characteristics and outcomes among patients with VKA-or DOAC-related ICH. Results: We prospectively evaluated 161 patients with anticoagulation-related ICH (mean age 75.66 9.8 years, 57.8% men, median admission NIH Stroke Scale [NIHSSadm] score 13 points, interquartile range 6-21). DOAC-related (n 5 47) and VKA-related (n 5 114) ICH did not differ in demographics, vascular risk factors, HAS-BLED and CHA2DS2-VASc scores, and antiplatelet pretreatment except for a higher prevalence of chronic kidney disease in VKA-related ICH. Patients with DOAC-related ICH had lower median NIHSSadm scores (8 [3-14] vs 15 [7-25] points, p 5 0.003), median baseline hematoma volume (12.8 [4-40] vs 24.3 [11-58.8] cm3, p 5 0.007), and median ICH score (1 [0-2] vs 2 [1-3] points, p5 0.049). Severe ICH (.2 points) was less prevalent in DOAC-related ICH (17.0% vs 36.8%, p 5 0.013). In multivariable analyses, DOAC-related ICH was independently associated with lower baseline hematoma volume (p 5 0.006), lower NIHSSadm scores (p 5 0.022), and lower likelihood of severe ICH (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.13-0.87, p 5 0.025). In meta-analysis of eligible studies, DOAC-related ICH was associated with lower baseline hematoma volumes on admission CT (standardized mean difference 5 20.57, 95% CI 21.02 to 20.12, p 5 0.010) and lower in-hospital mortality rates (OR 5 0.44, 95% CI 0.21-0.91, p 5 0.030). Conclusions: DOAC-related ICH is associatedwith smaller baseline hematoma volume and lesser neurologic deficit at hospital admission compared to VKA-related ICH. © 2017 American Academy of Neurology."
}