Universität zu Köln

Gerner, Stefan T., Kuramatsu, Joji B., Sembill, Jochen A. ORCID: 0000-0003-0014-3389, Spruegel, Maximilian I., Endres, Matthias, Haeusler, Karl Georg, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan, Rizos, Timolaos, Erbguth, Frank, Schellinger, Peter D., Fink, Gereon R. ORCID: 0000-0002-8230-1856, Stetefeld, Henning, Schneider, Hauke ORCID: 0000-0002-9641-0922, Neugebauer, Hermann ORCID: 0000-0003-3759-356X, Roether, Joachim, Classen, Joseph ORCID: 0000-0001-7182-6967, Michalski, Dominik, Doerfler, Arnd, Schwab, Stefan and Huttner, Hagen B. (2018). Association of Prothrombin Complex Concentrate Administration and Hematoma Enlargement in Non-Vitamin K Antagonist Oral Anticoagulant-Related Intracerebral Hemorrhage. Ann. Neurol., 83 (1). S. 186 - 197. HOBOKEN: WILEY. ISSN 1531-8249

Full text not available from this repository.

Abstract

Objective: To investigate parameters associated with hematoma enlargement in non-vitamin K antagonist oral anticoagulant (NOAC)-related intracerebral hemorrhage (ICH). Methods: This retrospective cohort study includes individual patient data for 190 patients with NOAC-associated ICH over a 5-year period (2011-2015) at 19 departments of neurology across Germany. Primary outcome was the association of prothrombin complex concentrate (PCC) administration with hematoma enlargement. Subanalyses were calculated for blood pressure management and its association with the primary outcome. Secondary outcomes include associations with in-hospital mortality and functional outcome at 3 months assessed using the modified Rankin Scale. Results: The study population for analysis of primary and secondary outcomes consisted of 146 NOAC-ICH patients with available follow-up imaging. Hematoma enlargement occurred in 49/146 (33.6%) patients with NOAC-related ICH. Parameters associated with hematoma enlargement were blood pressure >= 160mmHg within 4 hours and-in the case of factor Xa inhibitor ICH-anti-Xa levels on admission. PCC administration prior to follow-up imaging was not significantly associated with a reduced rate of hematoma enlargement either in overall NOAC-related ICH or in patients with factor Xa inhibitor intake (NOAC: risk ratio [RR] = 1.150, 95% confidence interval [CI] = 0.632-2.090; factor Xa inhibitor: RR = 1.057, 95% CI = 0.565-1.977), regardless of PCC dosage given or time interval until imaging or treatment. Systolic blood pressure levels < 160mmHg within 4 hours after admission were significantly associated with a reduction in the proportion of patients with hematoma enlargement (RR = 0.598, 95% CI = 0.365-0.978). PCC administration had no effect on mortality and functional outcome either at discharge or at 3 months. Interpretation: In contrast to blood pressure control, PCC administration was not associated with a reduced rate of hematoma enlargement in NOAC-related ICH. Our findings support the need of further investigations exploring new hemostatic reversal strategies for patients with factor Xa inhibitor-related ICH.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gerner, Stefan T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuramatsu, Joji B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sembill, Jochen A. UNSPECIFIED orcid.org/0000-0003-0014-3389 UNSPECIFIED Spruegel, Maximilian I. UNSPECIFIED UNSPECIFIED UNSPECIFIED Endres, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Haeusler, Karl Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Vajkoczy, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Ringleb, Peter A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Purrucker, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Rizos, Timolaos UNSPECIFIED UNSPECIFIED UNSPECIFIED Erbguth, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Schellinger, Peter D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fink, Gereon R. UNSPECIFIED orcid.org/0000-0002-8230-1856 UNSPECIFIED Stetefeld, Henning UNSPECIFIED UNSPECIFIED UNSPECIFIED Schneider, Hauke UNSPECIFIED orcid.org/0000-0002-9641-0922 UNSPECIFIED Neugebauer, Hermann UNSPECIFIED orcid.org/0000-0003-3759-356X UNSPECIFIED Roether, Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Classen, Joseph UNSPECIFIED orcid.org/0000-0001-7182-6967 UNSPECIFIED Michalski, Dominik UNSPECIFIED UNSPECIFIED UNSPECIFIED Doerfler, Arnd UNSPECIFIED UNSPECIFIED UNSPECIFIED Schwab, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Huttner, Hagen B. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-200004
DOI:	10.1002/ana.25134
Journal or Publication Title:	Ann. Neurol.
Volume:	83
Number:	1
Page Range:	S. 186 - 197
Date:	2018
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1531-8249
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NONVALVULAR ATRIAL-FIBRILLATION; ACUTE CEREBRAL-HEMORRHAGE; FACTOR XA INHIBITORS; INTRAVENTRICULAR HEMORRHAGE; INTRACRANIAL HEMORRHAGE; RANDOMIZED-TRIALS; PRACTICAL GUIDE; REVERSAL; MANAGEMENT; BLOOD Multiple languages Clinical Neurology; Neurosciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/20000