Neuroimaging characteristics and clinical outcomes in functionally independent patients presenting with oral anticoagulant related nontraumatic intracerebral hemorrhage
Lioutas VA, Goyal N, Katsanos A, Krogias C, Zand R, Sharma V, Varelas P, Malhotra K, Paciaroni M, Sharaf A, Chang J, Karapanayiotides T, Kargiotis O, Pappa A, Pandhi A, Tsantes A, Mehta C, Selim M, Alexandrov A, and Tsivgoulis G. Neuroimaging characteristics and clinical outcomes in functionally independent patients presenting with oral anticoagulant related nontraumatic intracerebral hemorrhage. Eur Stroke J 2018; 3(1 Suppl 1):437.
Eur Stroke J
Background and Aims: We have previously reported smaller hematoma volume and lesser presenting neurologic deficits in patients with intracerebral hemorrhage (ICH) due to direct oral anticoagulants (DOACs) as compared to vitamin K antagonists (VKA). We sought to prospectively validate our findings in functionally independent patients prior to index event. Method: We prospectively evaluated clinical, laboratory and imaging data from consecutive patients with non-traumatic, anticoagulation-related ICH admitted at 15 tertiary stroke care centers over a 12-month period. Results: Our cohort comprised 196 ICH patients: 62 DOAC-related (mean age 75.0±11.4 years, 54.8% men) and 134 VKA-related (mean age 72.3±10.5 years, 73.1% men). There were no differences in vascular comorbidities, HAS-BLED, CHA2DS2-VASc scores, antiplatelet and statin use; VKA-related ICH were more likely to be lobar (60.4% vs 32.2%, p10) (37% vs 55.3%, p=0.025). VKA-ICH had higher median 24-hr hematoma volume (20.0 [6.8-59] vs 15.9 [2.5-32.7] ml, p=0.02) and were more likely to have significant hematoma expansion (37.4% vs 17%, p=0.008) and midline shift (47 vs 36%, p=0.03) at 24hrs. Pretreatment with DOACs was independently associated with smaller baseline hematoma volume and lower likelihood of severe neurological deficits in multivariable models adjusting for potential confounders. Conclusion:We confirmed our previous findings in a prospective, multicenter cohort of functionally independent ICH patients. Patients with DOAC-related ICH have smaller baseline hematoma volume and lower odds of severe neurological deficits compared to VKA-related ICH.
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