Gerner, Stefan T., Kuramatsu, Joji B., Sembill, Jochen A. ORCID: 0000-0003-0014-3389, Spruegel, Maximilian I., Hagen, Manuel, Knappe, Ruben U., Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan C., Rizos, Timolaos, Volkmann, Jens, Muellges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, Erbguth, Frank, Nueckel, Martin, Schellinger, Peter D., Glahn, Joerg, Knappe, Ulrich J., Fink, Gereon R. ORCID: 0000-0002-8230-1856, Dohmen, Christian, Stetefeld, Henning, Fisse, Anna Lena, Minnerup, Jens, Hagemann, Georg, Rakers, Florian, Reichmann, Heinz, Schneider, Hauke ORCID: 0000-0002-9641-0922, Rahmig, Jan, Ludolph, Albert Christian, Stoesser, Sebastian, Neugebauer, Hermann ORCID: 0000-0003-3759-356X, Roether, Joachim, Michels, Peter, Schwarz, Michael, Reimann, Gernot, Baezner, Hansjoerg, Schwert, Henning, Classen, Joseph ORCID: 0000-0001-7182-6967, Michalski, Dominik, Grau, Armin, Palm, Frederick, Urbanek, Christian, Woehrle, Johannes C., Alshammari, Fahid, Horn, Markus, Bahner, Dirk, Witte, Otto W., Guenther, Albrecht, Hamann, Gerhard F., Engelhorn, Tobias, Luecking, Hannes, Doerfler, Arnd, Schwab, Stefan and Huttner, Hagen B. (2019). Characteristics in Non-Vitamin K Antagonist Oral Anticoagulant-Related Intracerebral Hemorrhage. Stroke, 50 (6). S. 1392 - 1403. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1524-4628

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Abstract

Background and Purpose Given inconclusive studies, it is debated whether clinical and imaging characteristics, as well as functional outcome, differ among patients with intracerebral hemorrhage (ICH) related to vitamin K antagonists (VKA) versus non-vitamin K antagonist (NOAC)-related ICH. Notably, clinical characteristics according to different NOAC agents and dosages are not established. Methods Multicenter observational cohort study integrating individual patient data of 1328 patients with oral anticoagulation-associated ICH, including 190 NOAC-related ICH patients, recruited from 2011 to 2015 at 19 tertiary centers across Germany. Imaging, clinical characteristics, and 3-months modified Rankin Scale (mRS) outcomes were compared in NOAC- versus VKA-related ICH patients. Propensity score matching was conducted to adjust for clinically relevant differences in baseline parameters. Subgroup analyses were performed regarding NOAC agent, dosing and present clinically relevant anticoagulatory activity (last intake <12h/24h or NOAC level >30 ng/mL). Results Despite older age in NOAC patients, there were no relevant differences in clinical and hematoma characteristics between NOAC- and VKA-related ICH regarding baseline hematoma volume (median [interquartile range]: NOAC, 14.7 [5.1-42.3] mL versus VKA, 16.4 [5.8-40.6] mL; P=0.33), rate of hematoma expansion (NOAC, 49/146 [33.6%] versus VKA, 235/688 [34.2%]; P=0.89), and the proportion of patients with unfavorable outcome at 3 months (mRS, 4-6: NOAC 126/179 [70.4%] versus VKA 473/682 [69.4%]; P=0.79). Subgroup analyses revealed that NOAC patients with clinically relevant anticoagulatory effect had higher rates of intraventricular hemorrhage (n/N [%]: present 52/109 [47.7%] versus absent 9/35 [25.7%]; P=0.022) and hematoma expansion (present 35/90 [38.9%] versus absent 5/30 [16.7%]; P=0.040), whereas type of NOAC agent or different NOAC-dosing regimens did not result in relevant differences in imaging characteristics or outcome. Conclusions If effectively anticoagulated, there are no differences in hematoma characteristics and functional outcome among patients with NOAC- or VKA-related ICH. Clinical Trial Registration

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Gerner, Stefan T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuramatsu, Joji B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sembill, Jochen A.UNSPECIFIEDorcid.org/0000-0003-0014-3389UNSPECIFIED
Spruegel, Maximilian I.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagen, ManuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Knappe, Ruben U.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Endres, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haeusler, Karl GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sobesky, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schurig, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zweynert, SarahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bauer, MiriamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vajkoczy, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ringleb, Peter A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Purrucker, Jan C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rizos, TimolaosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Volkmann, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muellges, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kraft, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schubert, Anna-LenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Erbguth, FrankUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nueckel, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schellinger, Peter D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Glahn, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Knappe, Ulrich J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fink, Gereon R.UNSPECIFIEDorcid.org/0000-0002-8230-1856UNSPECIFIED
Dohmen, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stetefeld, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fisse, Anna LenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Minnerup, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagemann, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rakers, FlorianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reichmann, HeinzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schneider, HaukeUNSPECIFIEDorcid.org/0000-0002-9641-0922UNSPECIFIED
Rahmig, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ludolph, Albert ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stoesser, SebastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neugebauer, HermannUNSPECIFIEDorcid.org/0000-0003-3759-356XUNSPECIFIED
Roether, JoachimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Michels, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwarz, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reimann, GernotUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baezner, HansjoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwert, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Classen, JosephUNSPECIFIEDorcid.org/0000-0001-7182-6967UNSPECIFIED
Michalski, DominikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grau, ArminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Palm, FrederickUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Urbanek, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Woehrle, Johannes C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alshammari, FahidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Horn, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bahner, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Witte, Otto W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guenther, AlbrechtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hamann, Gerhard F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Engelhorn, TobiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Luecking, HannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Doerfler, ArndUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwab, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huttner, Hagen B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-146852
DOI: 10.1161/STROKEAHA.118.023492
Journal or Publication Title: Stroke
Volume: 50
Number: 6
Page Range: S. 1392 - 1403
Date: 2019
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Place of Publication: PHILADELPHIA
ISSN: 1524-4628
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
PROTHROMBIN COMPLEX CONCENTRATE; ATRIAL-FIBRILLATION; INTRACRANIAL HEMORRHAGE; WARFARIN; ASSOCIATION; RESUMPTION; MANAGEMENT; REVERSALMultiple languages
Clinical Neurology; Peripheral Vascular DiseaseMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/14685

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