Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage

Georgios Tsivgoulis, Duncan Wilson, Aristeidis H. Katsanos, João Sargento-Freitas, Cláudia Marques-Matos, Elsa Azevedo, Tomohide Adachi, Christian von der Brelie, Yoshifusa Aizawa, Hiroshi Abe, Hirofumi Tomita, Ken Okumura, Joji Hagii, David J. Seiffge, Vasileios Arsenios Lioutas, Christopher Traenka, Panayiotis Varelas, Ghazala Basir, Christos Krogias, Jan C. Purrucker & 40 others Vijay K. Sharma, Timolaos Rizos, Robert Mikulik, Oluwaseun A. Sobowale, Kristian Barlinn, Hanne Sallinen, Nitin Goyal, Shin Joe Yeh, Theodore Karapanayiotides, Teddy Y. Wu, Konstantinos Vadikolias, Marc Ferrigno, Georgios Hadjigeorgiou, Rik Houben, Sotirios Giannopoulos, Floris H.B.M. Schreuder, Jason J. Chang, Luke A. Perry, Maximilian Mehdorn, João Pedro Marto, João Pinho, Jun Tanaka, Marion Boulanger, Rustam Al Shahi Salman, Hans R. Jäger, Clare Shakeshaft, Yusuke Yakushiji, Philip M.C. Choi, Julie Staals, Charlotte Cordonnier, Jiann Shing Jeng, Roland Veltkamp, Dar Dowlatshahi, Stefan T. Engelter, Adrian R. Parry-Jones, Atte Meretoja, Panayiotis D. Mitsias, Andrei Alexandrov, Gareth Ambler, David J. Werring

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: Whether intracerebral hemorrhage (ICH) associated with non–vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. Methods: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. Results: We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs 26.5%; hazard ratio = 0.94, 95% confidence interval [CI] = 0.67–1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = −2.83, 95% CI = −5.28 to −0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30–0.84), and smaller baseline hematoma volume (linear regression coefficient = −0.24, 95% CI = −0.47 to −0.16). The two groups did not differ in the likelihood of baseline hematoma volume < 30cm3 (OR = 1.14, 95% CI = 0.81–1.62), hematoma expansion (OR = 0.97, 95% CI = 0.63–1.48), in-hospital mortality (OR = 0.73, 95% CI = 0.49–1.11), functional status at discharge (common OR = 0.78, 95% CI = 0.57–1.07), or functional status at 3 months (common OR = 1.03, 95% CI = 0.75–1.43). Interpretation: Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702–712.

Original languageEnglish (US)
Pages (from-to)694-704
Number of pages11
JournalAnnals of Neurology
Volume84
Issue number5
DOIs
StatePublished - Nov 1 2018

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Cerebral Hemorrhage
Neuroimaging
Confidence Intervals
Odds Ratio
Hematoma
Stroke
National Institutes of Health (U.S.)
Linear Models
Multivariate Analysis
Vitamin K
Mortality
Hospital Mortality
N(4)-oleylcytosine arabinoside
Anticoagulants
Meta-Analysis

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Tsivgoulis, G., Wilson, D., Katsanos, A. H., Sargento-Freitas, J., Marques-Matos, C., Azevedo, E., ... Werring, D. J. (2018). Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage. Annals of Neurology, 84(5), 694-704. https://doi.org/10.1002/ana.25342

Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage. / Tsivgoulis, Georgios; Wilson, Duncan; Katsanos, Aristeidis H.; Sargento-Freitas, João; Marques-Matos, Cláudia; Azevedo, Elsa; Adachi, Tomohide; von der Brelie, Christian; Aizawa, Yoshifusa; Abe, Hiroshi; Tomita, Hirofumi; Okumura, Ken; Hagii, Joji; Seiffge, David J.; Lioutas, Vasileios Arsenios; Traenka, Christopher; Varelas, Panayiotis; Basir, Ghazala; Krogias, Christos; Purrucker, Jan C.; Sharma, Vijay K.; Rizos, Timolaos; Mikulik, Robert; Sobowale, Oluwaseun A.; Barlinn, Kristian; Sallinen, Hanne; Goyal, Nitin; Yeh, Shin Joe; Karapanayiotides, Theodore; Wu, Teddy Y.; Vadikolias, Konstantinos; Ferrigno, Marc; Hadjigeorgiou, Georgios; Houben, Rik; Giannopoulos, Sotirios; Schreuder, Floris H.B.M.; Chang, Jason J.; Perry, Luke A.; Mehdorn, Maximilian; Marto, João Pedro; Pinho, João; Tanaka, Jun; Boulanger, Marion; Salman, Rustam Al Shahi; Jäger, Hans R.; Shakeshaft, Clare; Yakushiji, Yusuke; Choi, Philip M.C.; Staals, Julie; Cordonnier, Charlotte; Jeng, Jiann Shing; Veltkamp, Roland; Dowlatshahi, Dar; Engelter, Stefan T.; Parry-Jones, Adrian R.; Meretoja, Atte; Mitsias, Panayiotis D.; Alexandrov, Andrei; Ambler, Gareth; Werring, David J.

In: Annals of Neurology, Vol. 84, No. 5, 01.11.2018, p. 694-704.

Research output: Contribution to journalArticle

Tsivgoulis, G, Wilson, D, Katsanos, AH, Sargento-Freitas, J, Marques-Matos, C, Azevedo, E, Adachi, T, von der Brelie, C, Aizawa, Y, Abe, H, Tomita, H, Okumura, K, Hagii, J, Seiffge, DJ, Lioutas, VA, Traenka, C, Varelas, P, Basir, G, Krogias, C, Purrucker, JC, Sharma, VK, Rizos, T, Mikulik, R, Sobowale, OA, Barlinn, K, Sallinen, H, Goyal, N, Yeh, SJ, Karapanayiotides, T, Wu, TY, Vadikolias, K, Ferrigno, M, Hadjigeorgiou, G, Houben, R, Giannopoulos, S, Schreuder, FHBM, Chang, JJ, Perry, LA, Mehdorn, M, Marto, JP, Pinho, J, Tanaka, J, Boulanger, M, Salman, RAS, Jäger, HR, Shakeshaft, C, Yakushiji, Y, Choi, PMC, Staals, J, Cordonnier, C, Jeng, JS, Veltkamp, R, Dowlatshahi, D, Engelter, ST, Parry-Jones, AR, Meretoja, A, Mitsias, PD, Alexandrov, A, Ambler, G & Werring, DJ 2018, 'Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage', Annals of Neurology, vol. 84, no. 5, pp. 694-704. https://doi.org/10.1002/ana.25342
Tsivgoulis G, Wilson D, Katsanos AH, Sargento-Freitas J, Marques-Matos C, Azevedo E et al. Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage. Annals of Neurology. 2018 Nov 1;84(5):694-704. https://doi.org/10.1002/ana.25342
Tsivgoulis, Georgios ; Wilson, Duncan ; Katsanos, Aristeidis H. ; Sargento-Freitas, João ; Marques-Matos, Cláudia ; Azevedo, Elsa ; Adachi, Tomohide ; von der Brelie, Christian ; Aizawa, Yoshifusa ; Abe, Hiroshi ; Tomita, Hirofumi ; Okumura, Ken ; Hagii, Joji ; Seiffge, David J. ; Lioutas, Vasileios Arsenios ; Traenka, Christopher ; Varelas, Panayiotis ; Basir, Ghazala ; Krogias, Christos ; Purrucker, Jan C. ; Sharma, Vijay K. ; Rizos, Timolaos ; Mikulik, Robert ; Sobowale, Oluwaseun A. ; Barlinn, Kristian ; Sallinen, Hanne ; Goyal, Nitin ; Yeh, Shin Joe ; Karapanayiotides, Theodore ; Wu, Teddy Y. ; Vadikolias, Konstantinos ; Ferrigno, Marc ; Hadjigeorgiou, Georgios ; Houben, Rik ; Giannopoulos, Sotirios ; Schreuder, Floris H.B.M. ; Chang, Jason J. ; Perry, Luke A. ; Mehdorn, Maximilian ; Marto, João Pedro ; Pinho, João ; Tanaka, Jun ; Boulanger, Marion ; Salman, Rustam Al Shahi ; Jäger, Hans R. ; Shakeshaft, Clare ; Yakushiji, Yusuke ; Choi, Philip M.C. ; Staals, Julie ; Cordonnier, Charlotte ; Jeng, Jiann Shing ; Veltkamp, Roland ; Dowlatshahi, Dar ; Engelter, Stefan T. ; Parry-Jones, Adrian R. ; Meretoja, Atte ; Mitsias, Panayiotis D. ; Alexandrov, Andrei ; Ambler, Gareth ; Werring, David J. / Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage. In: Annals of Neurology. 2018 ; Vol. 84, No. 5. pp. 694-704.
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title = "Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage",
abstract = "Objective: Whether intracerebral hemorrhage (ICH) associated with non–vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. Methods: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. Results: We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5{\%} females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3{\%} vs 26.5{\%}; hazard ratio = 0.94, 95{\%} confidence interval [CI] = 0.67–1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = −2.83, 95{\%} CI = −5.28 to −0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95{\%} CI = 0.30–0.84), and smaller baseline hematoma volume (linear regression coefficient = −0.24, 95{\%} CI = −0.47 to −0.16). The two groups did not differ in the likelihood of baseline hematoma volume < 30cm3 (OR = 1.14, 95{\%} CI = 0.81–1.62), hematoma expansion (OR = 0.97, 95{\%} CI = 0.63–1.48), in-hospital mortality (OR = 0.73, 95{\%} CI = 0.49–1.11), functional status at discharge (common OR = 0.78, 95{\%} CI = 0.57–1.07), or functional status at 3 months (common OR = 1.03, 95{\%} CI = 0.75–1.43). Interpretation: Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702–712.",
author = "Georgios Tsivgoulis and Duncan Wilson and Katsanos, {Aristeidis H.} and Jo{\~a}o Sargento-Freitas and Cl{\'a}udia Marques-Matos and Elsa Azevedo and Tomohide Adachi and {von der Brelie}, Christian and Yoshifusa Aizawa and Hiroshi Abe and Hirofumi Tomita and Ken Okumura and Joji Hagii and Seiffge, {David J.} and Lioutas, {Vasileios Arsenios} and Christopher Traenka and Panayiotis Varelas and Ghazala Basir and Christos Krogias and Purrucker, {Jan C.} and Sharma, {Vijay K.} and Timolaos Rizos and Robert Mikulik and Sobowale, {Oluwaseun A.} and Kristian Barlinn and Hanne Sallinen and Nitin Goyal and Yeh, {Shin Joe} and Theodore Karapanayiotides and Wu, {Teddy Y.} and Konstantinos Vadikolias and Marc Ferrigno and Georgios Hadjigeorgiou and Rik Houben and Sotirios Giannopoulos and Schreuder, {Floris H.B.M.} and Chang, {Jason J.} and Perry, {Luke A.} and Maximilian Mehdorn and Marto, {Jo{\~a}o Pedro} and Jo{\~a}o Pinho and Jun Tanaka and Marion Boulanger and Salman, {Rustam Al Shahi} and J{\"a}ger, {Hans R.} and Clare Shakeshaft and Yusuke Yakushiji and Choi, {Philip M.C.} and Julie Staals and Charlotte Cordonnier and Jeng, {Jiann Shing} and Roland Veltkamp and Dar Dowlatshahi and Engelter, {Stefan T.} and Parry-Jones, {Adrian R.} and Atte Meretoja and Mitsias, {Panayiotis D.} and Andrei Alexandrov and Gareth Ambler and Werring, {David J.}",
year = "2018",
month = "11",
day = "1",
doi = "10.1002/ana.25342",
language = "English (US)",
volume = "84",
pages = "694--704",
journal = "Annals of Neurology",
issn = "0364-5134",
publisher = "John Wiley and Sons Inc.",
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TY - JOUR

T1 - Neuroimaging and clinical outcomes of oral anticoagulant–associated intracerebral hemorrhage

AU - Tsivgoulis, Georgios

AU - Wilson, Duncan

AU - Katsanos, Aristeidis H.

AU - Sargento-Freitas, João

AU - Marques-Matos, Cláudia

AU - Azevedo, Elsa

AU - Adachi, Tomohide

AU - von der Brelie, Christian

AU - Aizawa, Yoshifusa

AU - Abe, Hiroshi

AU - Tomita, Hirofumi

AU - Okumura, Ken

AU - Hagii, Joji

AU - Seiffge, David J.

AU - Lioutas, Vasileios Arsenios

AU - Traenka, Christopher

AU - Varelas, Panayiotis

AU - Basir, Ghazala

AU - Krogias, Christos

AU - Purrucker, Jan C.

AU - Sharma, Vijay K.

AU - Rizos, Timolaos

AU - Mikulik, Robert

AU - Sobowale, Oluwaseun A.

AU - Barlinn, Kristian

AU - Sallinen, Hanne

AU - Goyal, Nitin

AU - Yeh, Shin Joe

AU - Karapanayiotides, Theodore

AU - Wu, Teddy Y.

AU - Vadikolias, Konstantinos

AU - Ferrigno, Marc

AU - Hadjigeorgiou, Georgios

AU - Houben, Rik

AU - Giannopoulos, Sotirios

AU - Schreuder, Floris H.B.M.

AU - Chang, Jason J.

AU - Perry, Luke A.

AU - Mehdorn, Maximilian

AU - Marto, João Pedro

AU - Pinho, João

AU - Tanaka, Jun

AU - Boulanger, Marion

AU - Salman, Rustam Al Shahi

AU - Jäger, Hans R.

AU - Shakeshaft, Clare

AU - Yakushiji, Yusuke

AU - Choi, Philip M.C.

AU - Staals, Julie

AU - Cordonnier, Charlotte

AU - Jeng, Jiann Shing

AU - Veltkamp, Roland

AU - Dowlatshahi, Dar

AU - Engelter, Stefan T.

AU - Parry-Jones, Adrian R.

AU - Meretoja, Atte

AU - Mitsias, Panayiotis D.

AU - Alexandrov, Andrei

AU - Ambler, Gareth

AU - Werring, David J.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Objective: Whether intracerebral hemorrhage (ICH) associated with non–vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. Methods: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. Results: We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs 26.5%; hazard ratio = 0.94, 95% confidence interval [CI] = 0.67–1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = −2.83, 95% CI = −5.28 to −0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30–0.84), and smaller baseline hematoma volume (linear regression coefficient = −0.24, 95% CI = −0.47 to −0.16). The two groups did not differ in the likelihood of baseline hematoma volume < 30cm3 (OR = 1.14, 95% CI = 0.81–1.62), hematoma expansion (OR = 0.97, 95% CI = 0.63–1.48), in-hospital mortality (OR = 0.73, 95% CI = 0.49–1.11), functional status at discharge (common OR = 0.78, 95% CI = 0.57–1.07), or functional status at 3 months (common OR = 1.03, 95% CI = 0.75–1.43). Interpretation: Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702–712.

AB - Objective: Whether intracerebral hemorrhage (ICH) associated with non–vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. Methods: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. Results: We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs 26.5%; hazard ratio = 0.94, 95% confidence interval [CI] = 0.67–1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = −2.83, 95% CI = −5.28 to −0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30–0.84), and smaller baseline hematoma volume (linear regression coefficient = −0.24, 95% CI = −0.47 to −0.16). The two groups did not differ in the likelihood of baseline hematoma volume < 30cm3 (OR = 1.14, 95% CI = 0.81–1.62), hematoma expansion (OR = 0.97, 95% CI = 0.63–1.48), in-hospital mortality (OR = 0.73, 95% CI = 0.49–1.11), functional status at discharge (common OR = 0.78, 95% CI = 0.57–1.07), or functional status at 3 months (common OR = 1.03, 95% CI = 0.75–1.43). Interpretation: Although functional outcome at discharge, 1 month, or 3 months was comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline hematoma volumes and less severe acute stroke syndromes. Ann Neurol 2018;84:702–712.

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