Alessandro Biffi1,2,3, Joji B Kuramatsu4, Audrey Leasure5, Hooman Kamel6, Christina Kourkoulis1,2,3, Kristin Schwab1,3, Alison M Ayres1,3, Jordan Elm7, M Edip Gurol1,3, Steven M Greenberg1,3, Anand Viswanathan1,3, Christopher D Anderson1,2,3, Stefan Schwab4, Jonathan Rosand1,2,3, Fernando D Testai8, Daniel Woo9, Hagen B Huttner4, Kevin N Sheth5. 1. Department of Neurology, Massachusetts General Hospital, Boston, MA. 2. Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA. 3. Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA. 4. Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany. 5. Department of Neurology, Yale University School of Medicine, New Haven, CT. 6. Department of Neurology, Weill Cornell College of Medicine, New York, NY. 7. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC. 8. Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL. 9. Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH.
Abstract
OBJECTIVE: Oral anticoagulation treatment (OAT) resumption is a therapeutic dilemma in intracerebral hemorrhage (ICH) care, particularly for lobar hemorrhages related to amyloid angiopathy. We sought to determine whether OAT resumption after ICH is associated with long-term outcome, accounting for ICH location (ie, lobar vs nonlobar). METHODS: We meta-analyzed individual patient data from: (1) the multicenter RETRACE study (n = 542), (2) a U.S.-based single-center ICH study (n = 261), and (3) the Ethnic/Racial Variations of Intracerebral Hemorrhage study (n = 209). We determined whether, within 1 year from ICH, OAT resumption was associated with: (1) mortality, (2) favorable functional outcome (modified Rankin Scale = 0-3), and (3) stroke incidence. We separately analyzed nonlobar and lobar ICH cases using propensity score matching and Cox regression models. RESULTS: We included 1,012 OAT-related ICH survivors (633 nonlobar and 379 lobar). Among nonlobar ICH survivors, 178/633 (28%) resumed OAT, whereas 86/379 (23%) lobar ICH survivors did. In multivariate analyses, OAT resumption after nonlobar ICH was associated with decreased mortality (hazard ratio [HR] = 0.25, 95% confidence interval [CI] = 0.14-0.44, p < 0.0001) and improved functional outcome (HR = 4.22, 95% CI = 2.57-6.94, p < 0.0001). OAT resumption after lobar ICH was also associated with decreased mortality (HR = 0.29, 95% CI = 0.17-0.45, p < 0.0001) and favorable functional outcome (HR = 4.08, 95% CI = 2.48-6.72, p < 0.0001). Furthermore, OAT resumption was associated with decreased all-cause stroke incidence in both lobar and nonlobar ICH (both p < 0.01). INTERPRETATION: These results suggest novel evidence of an association between OAT resumption and outcome following ICH, regardless of hematoma location. These findings support conducting randomized trials to explore risks and benefits of OAT resumption after ICH. Ann Neurol 2017;82:755-765.
OBJECTIVE: Oral anticoagulation treatment (OAT) resumption is a therapeutic dilemma in intracerebral hemorrhage (ICH) care, particularly for lobar hemorrhages related to amyloid angiopathy. We sought to determine whether OAT resumption after ICH is associated with long-term outcome, accounting for ICH location (ie, lobar vs nonlobar). METHODS: We meta-analyzed individual patient data from: (1) the multicenter RETRACE study (n = 542), (2) a U.S.-based single-center ICH study (n = 261), and (3) the Ethnic/Racial Variations of Intracerebral Hemorrhage study (n = 209). We determined whether, within 1 year from ICH, OAT resumption was associated with: (1) mortality, (2) favorable functional outcome (modified Rankin Scale = 0-3), and (3) stroke incidence. We separately analyzed nonlobar and lobar ICH cases using propensity score matching and Cox regression models. RESULTS: We included 1,012 OAT-related ICH survivors (633 nonlobar and 379 lobar). Among nonlobar ICH survivors, 178/633 (28%) resumed OAT, whereas 86/379 (23%) lobar ICH survivors did. In multivariate analyses, OAT resumption after nonlobar ICH was associated with decreased mortality (hazard ratio [HR] = 0.25, 95% confidence interval [CI] = 0.14-0.44, p < 0.0001) and improved functional outcome (HR = 4.22, 95% CI = 2.57-6.94, p < 0.0001). OAT resumption after lobar ICH was also associated with decreased mortality (HR = 0.29, 95% CI = 0.17-0.45, p < 0.0001) and favorable functional outcome (HR = 4.08, 95% CI = 2.48-6.72, p < 0.0001). Furthermore, OAT resumption was associated with decreased all-cause stroke incidence in both lobar and nonlobar ICH (both p < 0.01). INTERPRETATION: These results suggest novel evidence of an association between OAT resumption and outcome following ICH, regardless of hematoma location. These findings support conducting randomized trials to explore risks and benefits of OAT resumption after ICH. Ann Neurol 2017;82:755-765.
Authors: Jeremy A Rassen; Abhi A Shelat; Jessica Myers; Robert J Glynn; Kenneth J Rothman; Sebastian Schneeweiss Journal: Pharmacoepidemiol Drug Saf Date: 2012-05 Impact factor: 2.890
Authors: J Claude Hemphill; Steven M Greenberg; Craig S Anderson; Kyra Becker; Bernard R Bendok; Mary Cushman; Gordon L Fung; Joshua N Goldstein; R Loch Macdonald; Pamela H Mitchell; Phillip A Scott; Magdy H Selim; Daniel Woo Journal: Stroke Date: 2015-05-28 Impact factor: 7.914
Authors: Alessandro Biffi; Christopher D Anderson; Thomas W K Battey; Alison M Ayres; Steven M Greenberg; Anand Viswanathan; Jonathan Rosand Journal: JAMA Date: 2015-09-01 Impact factor: 56.272
Authors: Thorsten Steiner; Rustam Al-Shahi Salman; Ronnie Beer; Hanne Christensen; Charlotte Cordonnier; Laszlo Csiba; Michael Forsting; Sagi Harnof; Catharina J M Klijn; Derk Krieger; A David Mendelow; Carlos Molina; Joan Montaner; Karsten Overgaard; Jesper Petersson; Risto O Roine; Erich Schmutzhard; Karsten Schwerdtfeger; Christian Stapf; Turgut Tatlisumak; Brenda M Thomas; Danilo Toni; Andreas Unterberg; Markus Wagner Journal: Int J Stroke Date: 2014-08-24 Impact factor: 5.266
Authors: Victor J Del Brutto; Seemant Chaturvedi; Hans-Christoph Diener; Jose G Romano; Ralph L Sacco Journal: J Am Coll Cardiol Date: 2019-08-13 Impact factor: 24.094
Authors: Jochen A Sembill; Claudia Y Wieser; Maximilian I Sprügel; Stefan T Gerner; Antje Giede-Jeppe; Caroline Reindl; Ilker Y Eyüpoglu; Philip Hoelter; Hannes Lücking; Joji B Kuramatsu; Hagen B Huttner Journal: J Neurol Date: 2018-08-20 Impact factor: 4.849
Authors: Meredith P Murphy; Joji B Kuramatsu; Audrey Leasure; Guido J Falcone; Hooman Kamel; Lauren H Sansing; Christina Kourkoulis; Kristin Schwab; Jordan J Elm; M Edip Gurol; Huy Tran; Steven M Greenberg; Anand Viswanathan; Christopher D Anderson; Stefan Schwab; Jonathan Rosand; Fu-Dong Shi; Steven J Kittner; Fernando D Testai; Daniel Woo; Carl D Langefeld; Michael L James; Sebastian Koch; Hagen B Huttner; Alessandro Biffi; Kevin N Sheth Journal: Stroke Date: 2018-11 Impact factor: 7.914
Authors: Santosh B Murthy; Xian Wu; Ivan Diaz; Melvin Parasram; Neal S Parikh; Costantino Iadecola; Alexander E Merkler; Guido J Falcone; Stacy Brown; Alessandro Biffi; Judy Ch'ang; Jared Knopman; Philip E Stieg; Babak B Navi; Kevin N Sheth; Hooman Kamel Journal: Stroke Date: 2020-03-17 Impact factor: 7.914
Authors: Agnieszka Kotalczyk; Michał Mazurek; Zbigniew Kalarus; Tatjana S Potpara; Gregory Y H Lip Journal: Nat Rev Cardiol Date: 2020-10-27 Impact factor: 32.419
Authors: Jakob I Doerrfuss; Azmil H Abdul-Rahim; Bob Siegerink; Christian H Nolte; Kennedy R Lees; Matthias Endres; Scott E Kasner; Jan F Scheitz Journal: Eur Stroke J Date: 2019-11-25