TY - JOUR
TI - Direct oral anticoagulant-vs Vitamin K antagonist-related nontraumatic intracerebral hemorrhage
AU - Tsivgoulis, G.
AU - Lioutas, V.-A.
AU - Varelas, P.
AU - Katsanos, A.H.
AU - Goyal, N.
AU - Mikulik, R.
AU - Barlinn, K.
AU - Krogias, C.
AU - Sharma, V.K.
AU - Vadikolias, K.
AU - Dardiotis, E.
AU - Karapanayiotides, T.
AU - Pappa, A.
AU - Zompola, C.
AU - Triantafyllou, S.
AU - Kargiotis, O.
AU - Ioakeimidis, M.
AU - Giannopoulos, S.
AU - Kerro, A.
AU - Tsantes, A.
AU - Mehta, C.
AU - Jones, M.
AU - Schroeder, C.
AU - Norton, C.
AU - Bonakis, A.
AU - Chang, J.
AU - Alexandrov, A.W.
AU - Mitsias, P.
AU - Alexandrov, A.V.
JO - Functional Neurology
PY - 2017
VL - 89
TODO - 11
SP - 1142-1151
PB - Lippincott Williams and Wilkins
SN - null
TODO - 10.1212/WNL.0000000000004362
TODO - 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
TODO - 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.
ER -