Duncan Wilson1, Andreas Charidimou1, Clare Shakeshaft1, Gareth Ambler1, Mark White1, Hannah Cohen1, Tarek Yousry1, Rustam Al-Shahi Salman1, Gregory Y H Lip1, Martin M Brown1, Hans Rolf Jäger1, David J Werring2. 1. From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK. 2. From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK. d.werring@ucl.ac.uk.
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.
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.
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