TY - JOUR
TI - Clinical outcomes and neuroimaging profiles in nondisabled patients with anticoagulant-related intracerebral hemorrhage
AU - Lioutas, V.-A.
AU - Goyal, N.
AU - Katsanos, A.H.
AU - Krogias, C.
AU - Zand, R.
AU - Sharma, V.K.
AU - Varelas, P.
AU - Malhotra, K.
AU - Paciaroni, M.
AU - Sharaf, A.
AU - Chang, J.
AU - Karapanayiotides, T.
AU - Kargiotis, O.
AU - Pappa, A.
AU - Mai, J.
AU - Pandhi, A.
AU - Schroeder, C.
AU - Tsantes, A.
AU - Mehta, C.
AU - Kerro, A.
AU - Khan, A.
AU - Mitsias, P.D.
AU - Selim, M.H.
AU - Alexandrov, A.V.
AU - Tsivgoulis, G.
JO - ISRN Stroke
PY - 2018
VL - 49
TODO - 10
SP - 2309-2316
PB - Lippincott Williams and Wilkins
SN - 2090-9454
TODO - 10.1161/STROKEAHA.118.021979
TODO - andexanet alfa;  anticoagulant agent;  antithrombocytic agent;  antivitamin K;  hydroxymethylglutaryl coenzyme A reductase inhibitor;  idarucizumab;  anticoagulant agent;  vitamin K group;  warfarin, aged;  brain hematoma;  brain hemorrhage;  clinical outcome;  cohort analysis;  comorbidity;  Conference Paper;  female;  human;  major clinical study;  male;  mortality;  multivariate analysis;  National Institutes of Health Stroke Scale;  neuroimaging;  observational study;  priority journal;  prospective study;  Rankin scale;  tertiary care center;  brain hemorrhage;  hematoma;  middle aged;  oral drug administration;  treatment outcome;  very elderly, Administration, Oral;  Aged;  Aged, 80 and over;  Anticoagulants;  Cerebral Hemorrhage;  Female;  Hematoma;  Humans;  Male;  Middle Aged;  Neuroimaging;  Prospective Studies;  Treatment Outcome;  Vitamin K;  Warfarin
TODO - Background and Purpose: The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods: Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of <2 with acute nontraumatic anticoagulant-related ICH divided into 2 groups according to the type of anticoagulant: NOAC versus VKA. We recorded baseline ICH volume, significant hematoma expansion (absolute [12.5 mL] or relative [>33%] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results: Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0±11.4 years; 54.8% men) and 134 VKA related (mean age, 72.3±10.5; 73.1% men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37% versus 55.3%, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4% versus 17%, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:−0.415 [95% CI, −0.780 to −0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95% CI, 0.22−0.85) in multivariable-adjusted models. Conclusions-Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices. © 2018 American Heart Association, Inc.
ER -