Characteristics in Non-Vitamin K Antagonist Oral Anticoagulant-Related Intracerebral Hemorrhage

被引：33

作者：

Gerner, Stefan T. ^{[1
]}

Kuramatsu, Joji B. ^{[1
]}

Sembill, Jochen A. ^{[1
]}

Spruegel, Maximilian I. ^{[1
]}

Hagen, Manuel ^{[1
]}

Knappe, Ruben U. ^{[1
]}

Endres, Matthias ^{[3
,5
,6
,7
]}

Haeusler, Karl Georg ^{[3
,5
,9
]}

Sobesky, Jan ^{[3
,5
]}

Schurig, Johannes ^{[5
]}

Zweynert, Sarah ^{[3
]}

Bauer, Miriam ^{[5
]}

Vajkoczy, Peter ^{[4
]}

Ringleb, Peter A. ^{[8
]}

Purrucker, Jan C. ^{[8
]}

Rizos, Timolaos ^{[8
]}

Volkmann, Jens ^{[9
]}

Muellges, Wolfgang ^{[9
]}

Kraft, Peter ^{[9
]}

Schubert, Anna-Lena ^{[9
]}

Erbguth, Frank ^{[10
]}

Nueckel, Martin ^{[10
]}

Schellinger, Peter D. ^{[11
]}

Glahn, Joerg ^{[11
]}

Knappe, Ulrich J. ^{[12
]}

Fink, Gereon R. ^{[13
]}

Dohmen, Christian ^{[13
,14
]}

Stetefeld, Henning ^{[13
]}

Fisse, Anna Lena ^{[15
]}

Minnerup, Jens ^{[15
]}

Hagemann, Georg ^{[16
]}

Rakers, Florian ^{[16
]}

Reichmann, Heinz ^{[17
]}

Schneider, Hauke ^{[17
,18
]}

Rahmig, Jan ^{[17
]}

Ludolph, Albert Christian ^{[19
]}

Stoesser, Sebastian ^{[19
]}

Neugebauer, Hermann ^{[19
]}

Roether, Joachim ^{[20
]}

Michels, Peter ^{[20
]}

Schwarz, Michael ^{[21
]}

Reimann, Gernot ^{[21
]}

Baezner, Hansjoerg ^{[22
]}

Schwert, Henning ^{[22
]}

Classen, Joseph ^{[23
]}

Michalski, Dominik ^{[23
]}

Grau, Armin ^{[24
]}

Palm, Frederick ^{[24
]}

Urbanek, Christian ^{[24
]}

Woehrle, Johannes C. ^{[25
]}

机构：

[1] Univ Erlangen Nurnberg, Dept Neurol, Schwabachanlage 6, D-91054 Erlangen, Germany

[2] Univ Erlangen Nurnberg, Dept Neuroradiol, Erlangen, Germany

[3] Charite Univ Med Berlin, Dept Neurol, Berlin, Germany

[4] Charite Univ Med Berlin, Dept Neurosurg, Berlin, Germany

[5] Ctr Stroke Res Berlin, Berlin, Germany

[6] German Ctr Cardiovasc Res DZHK, Oudenarder Str, Berlin, Germany

[7] German Ctr Neurodegenerat Dis DZNE, Partner Site Berlin, Berlin, Germany

[8] Heidelberg Univ Hosp, Dept Neurol, Heidelberg, Germany

[9] Univ Wurzburg, Dept Neurol, Wurzburg, Germany

[10] Community Hosp Nuremberg, Dept Neurol, Nurnberg, Germany

[11] Ruhr Univ Bochum, Dept Neurol & Neurogeriatry, Johannes Wesling Med Ctr Minden, Univ Clin, Bochum, Germany

[12] Ruhr Univ Bochum, Dept Neurosurg, Johannes Wesling Med Ctr Minden, Univ Clin, Bochum, Germany

[13] Univ Cologne, Dept Neurol, Cologne, Germany

[14] LVR Klin Bonn, Dept Neurol, Bonn, Germany

[15] Univ Munster, Dept Neurol, Munster, Germany

[16] Community Hosp Helios Klinikum Berlin Buch, Berlin, Germany

[17] Univ Dresden, Dept Neurol, Dresden, Germany

[18] Klinikum Augsburg, Dept Neurol, Augsburg, Germany

[19] Univ Ulm, Dept Neurol, Ulm, Germany

[20] Community Hosp Asklepios Klin Hamburg Altona, Dept Neurol, Hamburg, Germany

[21] Community Hosp Klinikum Dortmund, Dept Neurol, Dortmund, Germany

[22] Community Hosp Klinikum Stuttgart, Dept Neurol, Stuttgart, Germany

[23] Univ Leipzig, Dept Neurol, Leipzig, Germany

[24] Community Hosp Klinikum Stadt Ludwigshafen Rhein, Dept Neurol, Ludwigshafen, Germany

[25] Community Hosp Klinikum Koblenz, Dept Neurol, Koblenz, Germany

[26] Community Hosp Bad Hersfeld, Dept Neurol, Bad Hersfeld, Germany

[27] Univ Jena, Dept Neurol, Jena, Germany

[28] Bezirkskrankenhaus Gunzburg, Dept Neurol & Neurol Rehabil, Gunzburg, Germany

来源：

STROKE | 2019年 / 50卷 / 06期

关键词：

anticoagulants; cerebral hemorrhage; Germany; hematoma; prognosis; vitamin K; PROTHROMBIN COMPLEX CONCENTRATE; ATRIAL-FIBRILLATION; INTRACRANIAL HEMORRHAGE; WARFARIN; ASSOCIATION; RESUMPTION; MANAGEMENT; REVERSAL;

D O I：

10.1161/STROKEAHA.118.023492

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose Given inconclusive studies, it is debated whether clinical and imaging characteristics, as well as functional outcome, differ among patients with intracerebral hemorrhage (ICH) related to vitamin K antagonists (VKA) versus non-vitamin K antagonist (NOAC)-related ICH. Notably, clinical characteristics according to different NOAC agents and dosages are not established. Methods Multicenter observational cohort study integrating individual patient data of 1328 patients with oral anticoagulation-associated ICH, including 190 NOAC-related ICH patients, recruited from 2011 to 2015 at 19 tertiary centers across Germany. Imaging, clinical characteristics, and 3-months modified Rankin Scale (mRS) outcomes were compared in NOAC- versus VKA-related ICH patients. Propensity score matching was conducted to adjust for clinically relevant differences in baseline parameters. Subgroup analyses were performed regarding NOAC agent, dosing and present clinically relevant anticoagulatory activity (last intake <12h/24h or NOAC level >30 ng/mL). Results Despite older age in NOAC patients, there were no relevant differences in clinical and hematoma characteristics between NOAC- and VKA-related ICH regarding baseline hematoma volume (median [interquartile range]: NOAC, 14.7 [5.1-42.3] mL versus VKA, 16.4 [5.8-40.6] mL; P=0.33), rate of hematoma expansion (NOAC, 49/146 [33.6%] versus VKA, 235/688 [34.2%]; P=0.89), and the proportion of patients with unfavorable outcome at 3 months (mRS, 4-6: NOAC 126/179 [70.4%] versus VKA 473/682 [69.4%]; P=0.79). Subgroup analyses revealed that NOAC patients with clinically relevant anticoagulatory effect had higher rates of intraventricular hemorrhage (n/N [%]: present 52/109 [47.7%] versus absent 9/35 [25.7%]; P=0.022) and hematoma expansion (present 35/90 [38.9%] versus absent 5/30 [16.7%]; P=0.040), whereas type of NOAC agent or different NOAC-dosing regimens did not result in relevant differences in imaging characteristics or outcome. Conclusions If effectively anticoagulated, there are no differences in hematoma characteristics and functional outcome among patients with NOAC- or VKA-related ICH. Clinical Trial Registration

引用

页码：1392 / 1402

页数：11

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