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Tsivgoulis G, Wilson D, Katsanos AH, Sargento-Freitas J, Marques-Matos C, Azevedo E, Adachi T, von der Brelie C, Aizawa Y, Abe H, Tomita H, Okumura K, Hagii J, Seiffge DJ, Lioutas VA, Traenka C, Varelas P, Basir G, Krogias C, Purrucker JC, Sharma VK, Rizos T, Mikulik R, Sobowale OA, Barlinn K, Sallinen H, Goyal N, Yeh SJ, Karapanayiotides T, Wu TY, Vadikolias K, Ferrigno M, Hadjigeorgiou G, Houben R, Giannopoulos S, Schreuder FHBM, Chang JJ, Perry LA, Mehdorn M, Marto JP, Pinho J, Tanaka J, Boulanger M, Al-Shahi Salman R, Jäger HR, Shakeshaft C, Yakushiji Y, Choi PMC, Staals J, Cordonnier C, Jeng JS, Veltkamp R, Dowlatshahi D, Engelter ST, Parry-Jones AR, Meretoja A, Mitsias PD, Alexandrov AV, Ambler G, Werring DJ. Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage. Ann Neurol 2018; 84:694-704. [PMID: 30255970 DOI: 10.1002/ana.25342] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/11/2023]
Abstract
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 < 30cm3 (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.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Duncan Wilson
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom, New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Aristeidis H Katsanos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - João Sargento-Freitas
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cláudia Marques-Matos
- Department of Neurology, São João University Hospital Center, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elsa Azevedo
- Department of Neurology, São João University Hospital Center, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tomohide Adachi
- Department of Neurology and General Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Yoshifusa Aizawa
- Department of Research and Development, Tachikawa Medical Center, Nagaoka, Japan
| | - Hiroshi Abe
- Department of Research and Development, Tachikawa Medical Center, Nagaoka, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ken Okumura
- Advanced Arrhythmia Therapeutic Branch, Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - David J Seiffge
- Stroke Center and Neurology, University Hospital and University of Basel, Basel, Switzerland
| | | | - Christopher Traenka
- Stroke Center and Neurology, University Hospital and University of Basel, Basel, Switzerland
| | | | - Ghazala Basir
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Christos Krogias
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan C Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Vijay K Sharma
- Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Timolaos Rizos
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Mikulik
- International Clinical Research Center and Neurology Department, St Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Oluwaseun A Sobowale
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kristian Barlinn
- Department of Neurology, Dresden Neurovascular Center, Dresden, Germany
| | - Hanne Sallinen
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Shin-Joe Yeh
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan
| | - Theodore Karapanayiotides
- Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | | | - Marc Ferrigno
- Department of Neurology, Lille University, INSERM U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Lille, France
| | | | - Rik Houben
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sotirios Giannopoulos
- Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Floris H B M Schreuder
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jason J Chang
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Luke A Perry
- Department of Neurosciences, Eastern Health, Melbourne, Victoria, Australia
| | - Maximilian Mehdorn
- Department of Neurosurgery, Georg August University of Göttingen, Göttingen, Germany
| | - João-Pedro Marto
- Neurology Department, Egas Moniz Hospital, West Lisbon Hospital Center, Lisbon, Portugal.,CEDOC, Nova Medical School, New University of Lisbon, Lisbon, Portugal
| | - João Pinho
- Department of Neurology, Braga Hospital, Braga, Portugal
| | - Jun Tanaka
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Marion Boulanger
- Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Hans R Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, United Kingdom
| | - Clare Shakeshaft
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom, New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Philip M C Choi
- Department of Neurosciences, Eastern Health, Melbourne, Victoria, Australia
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Charlotte Cordonnier
- Department of Neurology, Lille University, INSERM U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Lille, France
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan
| | - Roland Veltkamp
- Division of Brain Sciences, Department of Stroke Medicine, Imperial College London, United Kingdom
| | - Dar Dowlatshahi
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Stefan T Engelter
- Stroke Center and Neurology, University Hospital and University of Basel, Basel, Switzerland.,Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland
| | - Adrian R Parry-Jones
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Atte Meretoja
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Medicine and Neurology at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Panayiotis D Mitsias
- Department of Neurology, Henry Ford Hospital, Detroit, MI.,Department of Neurology, School of Medicine, University of Crete, Crete, Greece
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, United Kingdom
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom, New Zealand Brain Research Institute, Christchurch, New Zealand
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