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Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage
Author(s) -
Tsivgoulis Georgios,
Wilson Duncan,
Katsanos Aristeidis H.,
SargentoFreitas João,
MarquesMatos Cláudia,
Azevedo Elsa,
Adachi Tomohide,
Brelie Christian,
Aizawa Yoshifusa,
Abe Hiroshi,
Tomita Hirofumi,
Okumura Ken,
Hagii Joji,
Seiffge David J.,
Lioutas VasileiosArsenios,
Traenka Christopher,
Varelas Panayiotis,
Basir Ghazala,
Krogias Christos,
Purrucker Jan C.,
Sharma Vijay K.,
Rizos Timolaos,
Mikulik Robert,
Sobowale Oluwaseun A.,
Barlinn Kristian,
Sallinen Hanne,
Goyal Nitin,
Yeh ShinJoe,
Karapanayiotides Theodore,
Wu Teddy Y.,
Vadikolias Konstantinos,
Ferrigno Marc,
Hadjigeorgiou Georgios,
Houben Rik,
Giannopoulos Sotirios,
Schreuder Floris H. B. M.,
Chang Jason J.,
Perry Luke A.,
Mehdorn Maximilian,
Marto JoãoPedro,
Pinho João,
Tanaka Jun,
Boulanger Marion,
AlShahi Salman Rustam,
Jäger Hans R.,
Shakeshaft Clare,
Yakushiji Yusuke,
Choi Philip M. C.,
Staals Julie,
Cordonnier Charlotte,
Jeng JiannShing,
Veltkamp Roland,
Dowlatshahi Dar,
Engelter Stefan T.,
ParryJones Adrian R.,
Meretoja Atte,
Mitsias Panayiotis D.,
Alexandrov Andrei V.,
Ambler Gareth,
Werring David J.
Publication year - 2018
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25342
Subject(s) - medicine , intracerebral hemorrhage , confidence interval , odds ratio , hazard ratio , stroke (engine) , hematoma , vitamin k antagonist , intraventricular hemorrhage , confounding , glasgow coma scale , anesthesia , surgery , warfarin , atrial fibrillation , pregnancy , mechanical engineering , biology , engineering , genetics , gestational age
Objective Whether intracerebral hemorrhage (ICH) associated with non–vitamin K antagonist oral anticoagulants (NOAC‐ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA‐ICH) is uncertain. Methods We performed a systematic review and individual patient data meta‐analysis of cohort studies comparing clinical and radiological outcomes between NOAC‐ICH and VKA‐ICH patients. The primary outcome measure was 30‐day all‐cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. Results We included 7 eligible studies comprising 219 NOAC‐ICH and 831 VKA‐ICH patients (mean age = 77 years, 52.5% females). The 30‐day mortality was similar between NOAC‐ICH and VKA‐ICH (24.3% vs 26.5%; hazard ratio = 0.94, 95% confidence interval [CI] = 0.67–1.31). However, in multivariate analyses adjusting for potential confounders, NOAC‐ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = −2.83, 95% CI = −5.28 to −0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30–0.84), and smaller baseline hematoma volume (linear regression coefficient = −0.24, 95% CI = −0.47 to −0.16). The two groups did not differ in the likelihood of baseline hematoma volume < 30cm 3 (OR = 1.14, 95% CI = 0.81–1.62), hematoma expansion (OR = 0.97, 95% CI = 0.63–1.48), in‐hospital mortality (OR = 0.73, 95% CI = 0.49–1.11), functional status at discharge (common OR = 0.78, 95% CI = 0.57–1.07), or functional status at 3 months (common OR = 1.03, 95% CI = 0.75–1.43). Interpretation Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC‐ICH and VKA‐ICH, patients with NOAC‐ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702–712