Georgios Tsivgoulis1,2, Duncan Wilson3, Aristeidis H Katsanos1,4, João Sargento-Freitas5,6, Cláudia Marques-Matos7,8, Elsa Azevedo7,8, Tomohide Adachi9, Christian von der Brelie10, Yoshifusa Aizawa11, Hiroshi Abe11, Hirofumi Tomita12, Ken Okumura13, Joji Hagii14, David J Seiffge15, Vasileios-Arsenios Lioutas16, Christopher Traenka15, Panayiotis Varelas17, Ghazala Basir18, Christos Krogias19, Jan C Purrucker20, Vijay K Sharma21, Timolaos Rizos20, Robert Mikulik22, Oluwaseun A Sobowale23, Kristian Barlinn24, Hanne Sallinen25, Nitin Goyal2, Shin-Joe Yeh26, Theodore Karapanayiotides27, Teddy Y Wu28, Konstantinos Vadikolias29, Marc Ferrigno30, Georgios Hadjigeorgiou31, Rik Houben32, Sotirios Giannopoulos4, Floris H B M Schreuder32,33, Jason J Chang2, Luke A Perry34, Maximilian Mehdorn10, João-Pedro Marto35,36, João Pinho37, Jun Tanaka38, Marion Boulanger39, Rustam Al-Shahi Salman39, Hans R Jäger40, Clare Shakeshaft3, Yusuke Yakushiji38, Philip M C Choi34, Julie Staals32, Charlotte Cordonnier30, Jiann-Shing Jeng26, Roland Veltkamp41, Dar Dowlatshahi18, Stefan T Engelter15,42, Adrian R Parry-Jones23, Atte Meretoja25,43, Panayiotis D Mitsias17,44, Andrei V Alexandrov2, Gareth Ambler45, David J Werring3. 1. Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 2. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN. 3. Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom, New Zealand Brain Research Institute, Christchurch, New Zealand. 4. Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece. 5. Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. 6. Faculty of Medicine, University of Coimbra, Coimbra, Portugal. 7. Department of Neurology, São João University Hospital Center, Porto, Portugal. 8. Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal. 9. Department of Neurology and General Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan. 10. Department of Neurosurgery, Georg August University of Göttingen, Göttingen, Germany. 11. Department of Research and Development, Tachikawa Medical Center, Nagaoka, Japan. 12. Department of Cardiology and Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. 13. Advanced Arrhythmia Therapeutic Branch, Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan. 14. Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan. 15. Stroke Center and Neurology, University Hospital and University of Basel, Basel, Switzerland. 16. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 17. Department of Neurology, Henry Ford Hospital, Detroit, MI. 18. Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada. 19. Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany. 20. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany. 21. Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 22. International Clinical Research Center and Neurology Department, St Anne's Hospital and Masaryk University, Brno, Czech Republic. 23. Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom. 24. Department of Neurology, Dresden Neurovascular Center, Dresden, Germany. 25. Department of Neurology, Helsinki University Hospital, Helsinki, Finland. 26. Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan. 27. Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 28. Department of Neurology, Christchurch Hospital, Christchurch, New Zealand. 29. Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece. 30. Department of Neurology, Lille University, INSERM U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Lille, France. 31. Department of Neurology, University of Thessaly, Larissa, Greece. 32. Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands. 33. Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands. 34. Department of Neurosciences, Eastern Health, Melbourne, Victoria, Australia. 35. Neurology Department, Egas Moniz Hospital, West Lisbon Hospital Center, Lisbon, Portugal. 36. CEDOC, Nova Medical School, New University of Lisbon, Lisbon, Portugal. 37. Department of Neurology, Braga Hospital, Braga, Portugal. 38. Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan. 39. Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom. 40. Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, United Kingdom. 41. Division of Brain Sciences, Department of Stroke Medicine, Imperial College London, United Kingdom. 42. Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland. 43. Department of Medicine and Neurology at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia. 44. Department of Neurology, School of Medicine, University of Crete, Crete, Greece. 45. Department of Statistical Science, University College London, London, United Kingdom.
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.
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-ICHpatients. 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-ICHpatients (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.
Authors: Stefano Magon; Charidimos Tsagkas; Laura Gaetano; Raihaan Patel; Yvonne Naegelin; Michael Amann; Katrin Parmar; Athina Papadopoulou; Jens Wuerfel; Christoph Stippich; Ludwig Kappos; M Mallar Chakravarty; Till Sprenger Journal: J Neurol Date: 2020-02-10 Impact factor: 4.849
Authors: M O Fakiri; M Uyttenboogaart; R Houben; R J van Oostenbrugge; J Staals; G J Luijckx Journal: Eur J Neurol Date: 2020-06-16 Impact factor: 6.089
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