Gustavo Zapata-Wainberg1, Sonia Quintas2, Álvaro Ximénez-Carrillo Rico1, Jaime Masjuán Vallejo3, Pere Cardona4, Mar Castellanos Rodrigo5, Lorena Benavente Fernández6, Andrés García Pastor7, José Egido8, José Maciñeiras9, Joaquín Serena10, María Del Mar Freijo Guerrero11, Francisco Moniche12, José Vivancos1. 1. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain. 2. Hospital Universitario de La Princesa, Madrid, Spain. 3. Hospital Universitario Ramón y Cajal, Madrid, Spain. 4. Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain. 5. Complejo Hospitalario Universitario A Coruña, Instituto de Investigacion Biomédica A Coruña, Coruña, Spain. 6. Hospital Universitario Central de Asturias, Oviedo, Spain. 7. Hospital General Universitario Gregorio Marañón, Madrid, Spain. 8. Hospital Clínico Universitario San Carlos, Madrid, Spain. 9. Complexo Hospitalario Universitario de Vigo, Vigo, Spain. 10. Hospital Universitario Dr. Josep Trueta, Girona, Spain. 11. Hospital de Basurto, Montevideo Etorb, Bilbao, Spain. 12. Hospital Universitario Virgen del Rocío, Seville, Spain.
Abstract
OBJECTIVE: Patients receiving treatment with oral anticoagulants (OACs) are at risk of intracranial hemorrhage (ICH). In this study, we describe the epidemiological and clinical characteristics of patients receiving OACs who experience ICH and compare those receiving vitamin K antagonists (ICH-VKAs) with those receiving direct OACs (ICH-DOACs). METHODS: We performed a national, multicenter, descriptive, observational, retrospective study of all adult patients receiving OACs who were admitted to the neurology department with ICH over a 1-year period. The study population was divided into 2 groups (ICH-VKAs and ICH-DOACs). Epidemiological, clinical, radiological, and therapy-related variables, as well as functional outcome, were compared at 3 months. A total of 366 cases were included (331 ICH-VKAs, 35 ICH- DOACs). RESULTS: The crude annual incidence of OAC-induced ICH was 3.8 (95% CI, 2.78-3.41) per 100,000 inhabitants/year. The mean (± SD) age was greater for ICH-DOACs (81.5 ± 8.3 vs. 77.7 ± 8.3 years; p = 0.012). The median (IQR) volume of the hemorrhage was lower for ICH-DOACs (11 [30.8] vs. 25 [50.7] mL; p = 0.03). The functional independence rate at 3 months (modified Rankin Scale, mRS < 3) was similar in both groups, although stroke-related mortality was greater in ICH-VKAs (40 vs. 72.7%; p = 0.02). The most frequently indicated poststroke antithrombotic therapy was DOACs (38.7%). CONCLUSION: We found that the incidence of OAC-induced ICH was greater than in previous studies. Hemorrhage volume and mortality were lower in ICH-DOACs than in ICH-VKAs. After stroke, DOACs were the most frequently indicated antithrombotic treatment.
OBJECTIVE: Patients receiving treatment with oral anticoagulants (OACs) are at risk of intracranial hemorrhage (ICH). In this study, we describe the epidemiological and clinical characteristics of patients receiving OACs who experience ICH and compare those receiving vitamin K antagonists (ICH-VKAs) with those receiving direct OACs (ICH-DOACs). METHODS: We performed a national, multicenter, descriptive, observational, retrospective study of all adult patients receiving OACs who were admitted to the neurology department with ICH over a 1-year period. The study population was divided into 2 groups (ICH-VKAs and ICH-DOACs). Epidemiological, clinical, radiological, and therapy-related variables, as well as functional outcome, were compared at 3 months. A total of 366 cases were included (331 ICH-VKAs, 35 ICH- DOACs). RESULTS: The crude annual incidence of OAC-induced ICH was 3.8 (95% CI, 2.78-3.41) per 100,000 inhabitants/year. The mean (± SD) age was greater for ICH-DOACs (81.5 ± 8.3 vs. 77.7 ± 8.3 years; p = 0.012). The median (IQR) volume of the hemorrhage was lower for ICH-DOACs (11 [30.8] vs. 25 [50.7] mL; p = 0.03). The functional independence rate at 3 months (modified Rankin Scale, mRS < 3) was similar in both groups, although stroke-related mortality was greater in ICH-VKAs (40 vs. 72.7%; p = 0.02). The most frequently indicated poststroke antithrombotic therapy was DOACs (38.7%). CONCLUSION: We found that the incidence of OAC-induced ICH was greater than in previous studies. Hemorrhage volume and mortality were lower in ICH-DOACs than in ICH-VKAs. After stroke, DOACs were the most frequently indicated antithrombotic treatment.
Entities:
Keywords:
Direct oral anticoagulants; Incidence; Intracranial hemorrhage; Neuroepidemiology; Oral anticoagulants; Vitamin K antagonists
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