Τίτλος:
Clinical outcomes and neuroimaging profiles in nondisabled patients with anticoagulant-related intracerebral hemorrhage
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Lioutas, V.-A.
Goyal, N.
Katsanos, A.H.
Krogias, C.
Zand, R.
Sharma, V.K.
Varelas, P.
Malhotra, K.
Paciaroni, M.
Sharaf, A.
Chang, J.
Karapanayiotides, T.
Kargiotis, O.
Pappa, A.
Mai, J.
Pandhi, A.
Schroeder, C.
Tsantes, A.
Mehta, C.
Kerro, A.
Khan, A.
Mitsias, P.D.
Selim, M.H.
Alexandrov, A.V.
Tsivgoulis, G.
Εκδότης:
Lippincott Williams and Wilkins
Λέξεις-κλειδιά:
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
DOI:
10.1161/STROKEAHA.118.021979
