Christian von der Brelie1,2, Alexandros Doukas3, Rebecca Naumann3, Astrid Dempfle4, Naomi Larsen5, Michael Synowitz3, Olav Jansen5, Maximilian Mehdorn3, Senol Jadik3. 1. Department of Neurosurgery, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany. cvdb@gmx.net. 2. Department of Neurosurgery, University Hospital of Göttingen, Robert Koch Strasse 40, 37075, Göttingen, Germany. cvdb@gmx.net. 3. Department of Neurosurgery, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany. 4. Institute of Medical Informatics and Statistics, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany. 5. Department of Radiology, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany.
Abstract
BACKGROUND: Clinical outcome and mortality in intracerebral haemorrhage (ICH) associated with anticoagulant treatment is poor. Novel direct oral anticoagulant drugs (NOACs) are increasingly prescribed. Management of NOAC-associated ICH might be more challenging. The aim of this study was to compare the clinical and radiological course of ICH patients being treated with different forms of oral anticoagulant drugs. METHOD: The study is a retrospective observational study. Haemorrhage in other intracranial compartments except the ventricular system were explicitly excluded. Four groups were categorised and compared with regard to their clinical and radiological course (NOACs, vitamin K antagonists [VKAs], platelet inhibitors and patients without anticoagulant/antiplatelet drugs). Clinical as well as radiological parameters were analysed. RESULTS: Overall, 182 patients were included (2011 to early 2016). Twenty-five patients with NOAC-associated ICH were included (47 with VKAs, 50 with platelet inhibitors and 60 patients without anticoagulant/antiplatelet drugs). The frequency of NOAC-associated ICH increased over the years. Diabetes was found significantly more often in the NOAC patients (p = 0.05). The clinical and radiological courses in the three different patient groups with impaired coagulation were similar. Mortality was significantly higher in patient groups with impaired coagulation (p = 0.04) compared to those without anticoagulant/antiplatelet drugs. Multivariate analysis revealed the Glasgow Coma Scale (GCS) score as a strong predictor for worse outcome and mortality. CONCLUSIONS: The frequency of NOAC-associated ICH increased in the last 5 years. Diabetes might be a risk factor for ICH when receiving NOACs. Clinical outcome in NOAC-associated ICH is poor and mortality is as high as in patients with other oral anticoagulant/antiplatelet drugs.
BACKGROUND: Clinical outcome and mortality in intracerebral haemorrhage (ICH) associated with anticoagulant treatment is poor. Novel direct oral anticoagulant drugs (NOACs) are increasingly prescribed. Management of NOAC-associated ICH might be more challenging. The aim of this study was to compare the clinical and radiological course of ICHpatients being treated with different forms of oral anticoagulant drugs. METHOD: The study is a retrospective observational study. Haemorrhage in other intracranial compartments except the ventricular system were explicitly excluded. Four groups were categorised and compared with regard to their clinical and radiological course (NOACs, vitamin K antagonists [VKAs], platelet inhibitors and patients without anticoagulant/antiplatelet drugs). Clinical as well as radiological parameters were analysed. RESULTS: Overall, 182 patients were included (2011 to early 2016). Twenty-five patients with NOAC-associated ICH were included (47 with VKAs, 50 with platelet inhibitors and 60 patients without anticoagulant/antiplatelet drugs). The frequency of NOAC-associated ICH increased over the years. Diabetes was found significantly more often in the NOAC patients (p = 0.05). The clinical and radiological courses in the three different patient groups with impaired coagulation were similar. Mortality was significantly higher in patient groups with impaired coagulation (p = 0.04) compared to those without anticoagulant/antiplatelet drugs. Multivariate analysis revealed the Glasgow Coma Scale (GCS) score as a strong predictor for worse outcome and mortality. CONCLUSIONS: The frequency of NOAC-associated ICH increased in the last 5 years. Diabetes might be a risk factor for ICH when receiving NOACs. Clinical outcome in NOAC-associated ICH is poor and mortality is as high as in patients with other oral anticoagulant/antiplatelet drugs.
Authors: Christopher Beynon; Steffen Brenner; Alexander Younsi; Timolaos Rizos; Jan-Oliver Neumann; Johannes Pfaff; Andreas W Unterberg Journal: Neurocrit Care Date: 2019-04 Impact factor: 3.210
Authors: Christian Ovesen; Jan Purrucker; Christian Gluud; Janus Christian Jakobsen; Hanne Christensen; Thorsten Steiner Journal: Syst Rev Date: 2018-10-20
Authors: David J Seiffge; Martina B Goeldlin; Turgut Tatlisumak; Philippe Lyrer; Urs Fischer; Stefan T Engelter; David J Werring Journal: J Neurol Date: 2019-09-20 Impact factor: 4.849