Direct Oral Anticoagulant-vs Vitamin K Antagonist-Related Nontraumatic Intracerebral Hemorrhage  

Oleh:

Tsivgoulis, Georgios ; Lioutas, Vasileios-Arsenios ; Varelas, Panayiotis ; Katsanos, Aristeidis H. ; Goyal, Nitin ; Mikulik, Robert ; Barlinn, Kristian ; Krogias, Christos ; Sharma, Vijay K. ; Vadikolias, Konstantinos ; Dardiotis, Efthymios ; Karapanayiotides, Theodore ; Pappa, Alexandra ; Zompola, Christina ; Triantafyllou, Sokratis ; Kargiotis, Odysseas ; Ioakeimidis, Michael ; Giannopoulos, Sotirios ; Kerro, Ali ; Tsantes, Argyrios ; Mehta, Chandan ; Jones, Mathew ; Schroeder, Christoph ; Norton, Casey ; Bonakis, Anastasios ; Chang, Jason J. ; Alexandrov, Anne W. ; Mitsias, Panayiotis ; Alexandrov, Andrei V.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Neurology (Official Journal of The American Academy of Neurology) vol. 89 no. 11 (Sep. 2017), page 1142-1151.
Topik: Vitamin K Antagonists; VKAs
Fulltext: N11 v89 n11 p1142 kelik2017.pdf (520.26KB)

Ketersediaan

Perpustakaan FK Nomor Panggil: N11.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Objective: To compare the neuroimaging profile and clinical outcomes among patients with intracerebral hemorrhage (ICH) related to use of vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF). Methods: We evaluated consecutive patients with NVAF with nontraumatic, anticoagulant-related ICH admitted at 13 tertiary stroke care centers over a 12-month period. We also performed a systematic review and meta-analysis of eligible observational studies reporting baseline characteristics and outcomes among patients with VKA- or DOAC-related ICH. Results: We prospectively evaluated 161 patients with anticoagulation-related ICH (mean age 75.6 ± 9.8 years, 57.8% men, median admission NIH Stroke Scale [NIHSSadm] score 13 points, interquartile range 6–21). DOAC-related (n = 47) and VKA-related (n = 114) ICH did not differ in demographics, vascular risk factors, HAS-BLED and CHA2DS2-VASc scores, and antiplatelet pretreatment except for a higher prevalence of chronic kidney disease in VKA-related ICH. Patients with DOAC-related ICH had lower median NIHSSadm scores (8 [3–14] vs 15 [7–25] points, p = 0.003), median baseline hematoma volume (12.8 [4–40] vs 24.3 [11–58.8] cm3, p = 0.007), and median ICH score (1 [0–2] vs 2 [1–3] points, p = 0.049). Severe ICH (>2 points) was less prevalent in DOAC-related ICH (17.0% vs 36.8%, p = 0.013). In multivariable analyses, DOAC-related ICH was independently associated with lower baseline hematoma volume (p = 0.006), lower NIHSSadm scores (p = 0.022), and lower likelihood of severe ICH (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.13–0.87, p = 0.025). In meta-analysis of eligible studies, DOAC-related ICH was associated with lower baseline hematoma volumes on admission CT (standardized mean difference = -0.57, 95% CI -1.02 to -0.12, p = 0.010) and lower in-hospital mortality rates (OR = 0.44, 95% CI 0.21–0.91, p = 0.030). Conclusions: DOAC-related ICH is associated with smaller baseline hematoma volume and lesser neurologic deficit at hospital admission compared to VKA-related ICH.

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