Clinical outcomes and neuroimaging profiles in nondisabled patients with anticoagulant-related intracerebral hemorrhage

Vasileios Arsenios Lioutas, Nitin Goyal, Aristeidis H. Katsanos, Christos Krogias, Ramin Zand, Vijay K. Sharma, Panayiotis Varelas, Konark Malhotra, Maurizio Paciaroni, Aboubakar Sharaf, Jason Chang, Theodore Karapanayiotides, Odysseas Kargiotis, Alexandra Pappa, Jeffrey Mai, Abhi Pandhi, Christoph Schroeder, Argyrios Tsantes, Chandan Mehta, Ali Kerro & 5 others Ayesha Khan, Panayiotis D. Mitsias, Magdy H. Selim, Andrei Alexandrov, Georgios Tsivgoulis

Research output: Contribution to journalArticle

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Abstract

Background and Purpose: The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods: Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of <2 with acute nontraumatic anticoagulant-related ICH divided into 2 groups according to the type of anticoagulant: NOAC versus VKA. We recorded baseline ICH volume, significant hematoma expansion (absolute [12.5 mL] or relative [>33%] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results: Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0±11.4 years; 54.8% men) and 134 VKA related (mean age, 72.3±10.5; 73.1% men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37% versus 55.3%, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4% versus 17%, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:−0.415 [95% CI, −0.780 to −0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95% CI, 0.22−0.85) in multivariable-adjusted models. Conclusions-Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices.

Original languageEnglish (US)
Pages (from-to)2309-2316
Number of pages8
JournalStroke
Volume49
Issue number10
DOIs
StatePublished - Jan 1 2018

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Cerebral Hemorrhage
Neuroimaging
Hematoma
Anticoagulants
Vitamin K
Stroke
National Institutes of Health (U.S.)
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Observational Studies
Blood Vessels
Comorbidity
Linear Models
Odds Ratio
Mortality

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Clinical outcomes and neuroimaging profiles in nondisabled patients with anticoagulant-related intracerebral hemorrhage. / Lioutas, Vasileios Arsenios; Goyal, Nitin; Katsanos, Aristeidis H.; Krogias, Christos; Zand, Ramin; Sharma, Vijay K.; Varelas, Panayiotis; Malhotra, Konark; Paciaroni, Maurizio; Sharaf, Aboubakar; Chang, Jason; Karapanayiotides, Theodore; Kargiotis, Odysseas; Pappa, Alexandra; Mai, Jeffrey; Pandhi, Abhi; Schroeder, Christoph; Tsantes, Argyrios; Mehta, Chandan; Kerro, Ali; Khan, Ayesha; Mitsias, Panayiotis D.; Selim, Magdy H.; Alexandrov, Andrei; Tsivgoulis, Georgios.

In: Stroke, Vol. 49, No. 10, 01.01.2018, p. 2309-2316.

Research output: Contribution to journalArticle

Lioutas, VA, Goyal, N, Katsanos, AH, Krogias, C, Zand, R, Sharma, VK, Varelas, P, Malhotra, K, Paciaroni, M, Sharaf, A, Chang, J, Karapanayiotides, T, Kargiotis, O, Pappa, A, Mai, J, Pandhi, A, Schroeder, C, Tsantes, A, Mehta, C, Kerro, A, Khan, A, Mitsias, PD, Selim, MH, Alexandrov, A & Tsivgoulis, G 2018, 'Clinical outcomes and neuroimaging profiles in nondisabled patients with anticoagulant-related intracerebral hemorrhage', Stroke, vol. 49, no. 10, pp. 2309-2316. https://doi.org/10.1161/STROKEAHA.118.021979
Lioutas, Vasileios Arsenios ; Goyal, Nitin ; Katsanos, Aristeidis H. ; Krogias, Christos ; Zand, Ramin ; Sharma, Vijay K. ; Varelas, Panayiotis ; Malhotra, Konark ; Paciaroni, Maurizio ; Sharaf, Aboubakar ; Chang, Jason ; Karapanayiotides, Theodore ; Kargiotis, Odysseas ; Pappa, Alexandra ; Mai, Jeffrey ; Pandhi, Abhi ; Schroeder, Christoph ; Tsantes, Argyrios ; Mehta, Chandan ; Kerro, Ali ; Khan, Ayesha ; Mitsias, Panayiotis D. ; Selim, Magdy H. ; Alexandrov, Andrei ; Tsivgoulis, Georgios. / Clinical outcomes and neuroimaging profiles in nondisabled patients with anticoagulant-related intracerebral hemorrhage. In: Stroke. 2018 ; Vol. 49, No. 10. pp. 2309-2316.
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abstract = "Background and Purpose: The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods: Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of <2 with acute nontraumatic anticoagulant-related ICH divided into 2 groups according to the type of anticoagulant: NOAC versus VKA. We recorded baseline ICH volume, significant hematoma expansion (absolute [12.5 mL] or relative [>33{\%}] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results: Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0±11.4 years; 54.8{\%} men) and 134 VKA related (mean age, 72.3±10.5; 73.1{\%} men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37{\%} versus 55.3{\%}, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4{\%} versus 17{\%}, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:−0.415 [95{\%} CI, −0.780 to −0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95{\%} CI, 0.22−0.85) in multivariable-adjusted models. Conclusions-Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices.",
author = "Lioutas, {Vasileios Arsenios} and Nitin Goyal and Katsanos, {Aristeidis H.} and Christos Krogias and Ramin Zand and Sharma, {Vijay K.} and Panayiotis Varelas and Konark Malhotra and Maurizio Paciaroni and Aboubakar Sharaf and Jason Chang and Theodore Karapanayiotides and Odysseas Kargiotis and Alexandra Pappa and Jeffrey Mai and Abhi Pandhi and Christoph Schroeder and Argyrios Tsantes and Chandan Mehta and Ali Kerro and Ayesha Khan and Mitsias, {Panayiotis D.} and Selim, {Magdy H.} and Andrei Alexandrov and Georgios Tsivgoulis",
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T1 - Clinical outcomes and neuroimaging profiles in nondisabled patients with anticoagulant-related intracerebral hemorrhage

AU - Lioutas, Vasileios Arsenios

AU - Goyal, Nitin

AU - Katsanos, Aristeidis H.

AU - Krogias, Christos

AU - Zand, Ramin

AU - Sharma, Vijay K.

AU - Varelas, Panayiotis

AU - Malhotra, Konark

AU - Paciaroni, Maurizio

AU - Sharaf, Aboubakar

AU - Chang, Jason

AU - Karapanayiotides, Theodore

AU - Kargiotis, Odysseas

AU - Pappa, Alexandra

AU - Mai, Jeffrey

AU - Pandhi, Abhi

AU - Schroeder, Christoph

AU - Tsantes, Argyrios

AU - Mehta, Chandan

AU - Kerro, Ali

AU - Khan, Ayesha

AU - Mitsias, Panayiotis D.

AU - Selim, Magdy H.

AU - Alexandrov, Andrei

AU - Tsivgoulis, Georgios

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background and Purpose: The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods: Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of <2 with acute nontraumatic anticoagulant-related ICH divided into 2 groups according to the type of anticoagulant: NOAC versus VKA. We recorded baseline ICH volume, significant hematoma expansion (absolute [12.5 mL] or relative [>33%] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results: Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0±11.4 years; 54.8% men) and 134 VKA related (mean age, 72.3±10.5; 73.1% men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37% versus 55.3%, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4% versus 17%, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:−0.415 [95% CI, −0.780 to −0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95% CI, 0.22−0.85) in multivariable-adjusted models. Conclusions-Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices.

AB - Background and Purpose: The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods: Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of <2 with acute nontraumatic anticoagulant-related ICH divided into 2 groups according to the type of anticoagulant: NOAC versus VKA. We recorded baseline ICH volume, significant hematoma expansion (absolute [12.5 mL] or relative [>33%] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results: Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0±11.4 years; 54.8% men) and 134 VKA related (mean age, 72.3±10.5; 73.1% men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37% versus 55.3%, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4% versus 17%, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:−0.415 [95% CI, −0.780 to −0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95% CI, 0.22−0.85) in multivariable-adjusted models. Conclusions-Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices.

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