Clinical and Radiological Characteristics of Vitamin K Versus Non-Vitamin K Antagonist Oral Anticoagulation-Related Intracerebral Hemorrhage
BACKGROUND/OBJECTIVE: Recent studies indicated that functional outcome after intracranial hemorrhage (ICH) related to direct oral anticoagulation (DOAC-ICH) is similar, if not better, than vitamin K antagonist (VKA)-related ICH (VKA-ICH) due to a smaller initial hematoma volume (HV). However, the association with hematoma expansion (HE) and location is not well understood.
METHODS: We retrospectively analyzed 102 consecutive patients with acute non-traumatic ICH on oral anticoagulation therapy to determine HV and HE stratified by hematoma location, and the relation to the 90-day outcome.
RESULTS: DOAC-ICH (n = 25) and VKA-ICH (n = 77) had a similar admission HV and HE (unadjusted p > 0.05, each). Targeted reversal strategies were used in 93.5% of VKA-ICH versus 8% of DOAC-ICH. After adjustment, an unfavorable 90-day functional outcome (modified Rankin scale score 4-6) was independently associated with a lower admission Glasgow Coma Scale score (OR 1.63; 95% CI 1.26-2.10; p < 0.001) and greater HV (OR 1.03; 95% confidence interval (CI) 1.00-1.05; p = 0.046). After exclusion of patients without follow-up head computed tomography to allow for adjustment by occurrence of HE, VKA-ICH was associated with an approximately 3.5 times greater odds for a poor 90-day outcome (OR 3.64; 95% CI 1.01-13.09; p = 0.048). However, there was no significant association of the oral anticoagulant strategy with 90-day outcome in the entire cohort (OR 2.85; 95% CI 0.69-11.86; p = 0.15).
CONCLUSIONS: DOAC use did not relate to worse HE, HV, and functional outcome after ICH, adding to the notion that DOAC is a safe alternative to VKA even in the absence of access to targeted reversal strategies (which are still not universally available).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
Neurocritical care - 31(2019), 1 vom: 28. Aug., Seite 56-65 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Miller, Małgorzata M [VerfasserIn] |
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| Links: |
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| Themen: |
12001-79-5 |
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| Anmerkungen: |
Date Completed 15.05.2020 Date Revised 21.01.2022 published: Print Citation Status MEDLINE |
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| doi: |
10.1007/s12028-019-00671-1 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM293179654 |
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| 041 | |a eng | ||
| 100 | 1 | |a Miller, Małgorzata M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical and Radiological Characteristics of Vitamin K Versus Non-Vitamin K Antagonist Oral Anticoagulation-Related Intracerebral Hemorrhage |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Revised 21.01.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND/OBJECTIVE: Recent studies indicated that functional outcome after intracranial hemorrhage (ICH) related to direct oral anticoagulation (DOAC-ICH) is similar, if not better, than vitamin K antagonist (VKA)-related ICH (VKA-ICH) due to a smaller initial hematoma volume (HV). However, the association with hematoma expansion (HE) and location is not well understood | ||
| 520 | |a METHODS: We retrospectively analyzed 102 consecutive patients with acute non-traumatic ICH on oral anticoagulation therapy to determine HV and HE stratified by hematoma location, and the relation to the 90-day outcome | ||
| 520 | |a RESULTS: DOAC-ICH (n = 25) and VKA-ICH (n = 77) had a similar admission HV and HE (unadjusted p > 0.05, each). Targeted reversal strategies were used in 93.5% of VKA-ICH versus 8% of DOAC-ICH. After adjustment, an unfavorable 90-day functional outcome (modified Rankin scale score 4-6) was independently associated with a lower admission Glasgow Coma Scale score (OR 1.63; 95% CI 1.26-2.10; p < 0.001) and greater HV (OR 1.03; 95% confidence interval (CI) 1.00-1.05; p = 0.046). After exclusion of patients without follow-up head computed tomography to allow for adjustment by occurrence of HE, VKA-ICH was associated with an approximately 3.5 times greater odds for a poor 90-day outcome (OR 3.64; 95% CI 1.01-13.09; p = 0.048). However, there was no significant association of the oral anticoagulant strategy with 90-day outcome in the entire cohort (OR 2.85; 95% CI 0.69-11.86; p = 0.15) | ||
| 520 | |a CONCLUSIONS: DOAC use did not relate to worse HE, HV, and functional outcome after ICH, adding to the notion that DOAC is a safe alternative to VKA even in the absence of access to targeted reversal strategies (which are still not universally available) | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Direct oral anticoagulants | |
| 650 | 4 | |a Intracranial hemorrhage | |
| 650 | 4 | |a Warfarin | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Vitamin K |2 NLM | |
| 650 | 7 | |a 12001-79-5 |2 NLM | |
| 700 | 1 | |a Lowe, Jessica |e verfasserin |4 aut | |
| 700 | 1 | |a Khan, Muhib |e verfasserin |4 aut | |
| 700 | 1 | |a Azeem, Muhammad U |e verfasserin |4 aut | |
| 700 | 1 | |a Muehlschlegel, Susanne |e verfasserin |4 aut | |
| 700 | 1 | |a Jun-O'Connell, Adalia H |e verfasserin |4 aut | |
| 700 | 1 | |a Goddeau, Richard P |c Jr |e verfasserin |4 aut | |
| 700 | 1 | |a Moonis, Majaz |e verfasserin |4 aut | |
| 700 | 1 | |a Gritters, Danielle |e verfasserin |4 aut | |
| 700 | 1 | |a Silver, Brian |e verfasserin |4 aut | |
| 700 | 1 | |a Henninger, Nils |e verfasserin |4 aut | |
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