Τίτλος:
Direct oral anticoagulant-vs Vitamin K antagonist-related nontraumatic intracerebral hemorrhage
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Tsivgoulis, G.
Lioutas, V.-A.
Varelas, P.
Katsanos, A.H.
Goyal, N.
Mikulik, R.
Barlinn, K.
Krogias, C.
Sharma, V.K.
Vadikolias, K.
Dardiotis, E.
Karapanayiotides, T.
Pappa, A.
Zompola, C.
Triantafyllou, S.
Kargiotis, O.
Ioakeimidis, M.
Giannopoulos, S.
Kerro, A.
Tsantes, A.
Mehta, C.
Jones, M.
Schroeder, C.
Norton, C.
Bonakis, A.
Chang, J.
Alexandrov, A.W.
Mitsias, P.
Alexandrov, A.V.
Περιοδικό:
Functional Neurology
Εκδότης:
Lippincott Williams and Wilkins
Λέξεις-κλειδιά:
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
DOI:
10.1212/WNL.0000000000004362
