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Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type

Research output: Contribution to journalJournal article

Published
  • Duncan Wilson
  • Andreas Charidimou
  • Clare Shakeshaft
  • Gareth Ambler
  • Mark White
  • Hannah Cohen
  • Tarek Yousry
  • Rustam Al-Shahi Salman
  • Gregory Y H Lip
  • Martin M Brown
  • Hans Rolf Jäger
  • David J Werring
  • Hedley Emsley
  • CROMIS-2 collaborators
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<mark>Journal publication date</mark>26/01/2016
<mark>Journal</mark>Neurology
Issue number4
Volume86
Number of pages7
Pages (from-to)360-366
Publication statusPublished
Early online date30/12/15
Original languageEnglish

Abstract

OBJECTIVE: To compare intracerebral hemorrhage (ICH) volume and clinical outcome of non-vitamin K oral anticoagulants (NOAC)-associated ICH to warfarin-associated ICH.

METHODS: In this multicenter cross-sectional observational study of patients with anticoagulant-associated ICH, consecutive patients with NOAC-ICH were compared to those with warfarin-ICH selected from a population of 344 patients with anticoagulant-associated ICH. ICH volume was measured by an observer blinded to clinical details. Outcome measures were ICH volume and clinical outcome adjusted for confounding factors.

RESULTS: We compared 11 patients with NOAC-ICH to 52 patients with warfarin-ICH. The median ICH volume was 2.4 mL (interquartile range [IQR] 0.3-5.4 mL) for NOAC-ICH vs 8.9 mL (IQR 4.0-21.3 mL) for warfarin-ICH (p = 0.0028). In univariate linear regression, use of warfarin (difference in cube root volume 1.61; 95% confidence interval [CI] 0.69 to 2.53) and lobar ICH location (compared with nonlobar ICH; difference in cube root volume 1.52; 95% CI 2.20 to 0.85) were associated with larger ICH volumes. In multivariable linear regression adjusting for confounding factors (sex, hypertension, previous ischemic stroke, white matter disease burden, and premorbid modified Rankin Scale score [mRS]), warfarin use remained independently associated with larger ICH (cube root) volumes (coefficient 0.64; 95% CI 0.24 to 1.25; p = 0.042). Ordered logistic regression showed an increased odds of a worse clinical outcome (as measured by discharge mRS) in warfarin-ICH compared with NOAC-ICH: odds ratio 4.46 (95% CI 1.10 to 18.14; p = 0.037).

CONCLUSIONS: In this small prospective observational study, patients with NOAC-associated ICH had smaller ICH volumes and better clinical outcomes compared with warfarin-associated ICH.