Abstract 216: Neuroimaging Profile and Outcomes in Vitamin K Antagonist and Direct Oral Anticoagulant Related Non-traumatic Intracerebral Hemorrhage
Background & Purpose: The safety and efficacy of direct oral anticoagulants (DOAC) for the prevention of thromboembolism in patients with non-valvular atrial fibrillation (NVAF) have been compared to vitamin-k antagonists (VKA) in randomized-controlled clinical trials. There are limited data regarding neuroimaging profile and outcomes in intracerebral hemorrhage (ICH) occurring during DOAC treatment. We sought to compare neuroimaging findings and outcomes in VKA- and DOAC-related ICH.
Methods: We prospectively evaluated consecutive NVAF patients with non-traumatic, anticoagulant-related ICH that were admitted during a 1-year period in 9 stroke centers. Baseline hematoma volume was calculated by ABC/2 formula. Baseline stroke severity and 3-month functional outcome (FO) were assessed using NIHSS- and mRS-scores. The ICH severity was determined using ICH-score (severe ICH: ICH-score of 3-5).
Results: We evaluated 91 patients with ICH due to DOAC (n=30) or VKA (n=61). The two groups did not differ in demographic, vascular risk factors, HAS-BLED & CHA2DS2-VASc scores, antithrombotic medications with the exception of higher renal failure prevalence in VKA (28% vs. 4%). DOAC group had significantly (p<0.05) lower median baseline NIHSS-score (5 vs. 12 points) and median baseline ICH volume (11 vs. 25 cm3). The rates of severe ICH (13% vs. 34%), perihematomal edema (44% vs.74%), midline shift (20% vs. 49%), 3-month disability (mRS-score: 3-6; 37% vs. 64%) and 3-month mortality (10% vs. 35%) were significantly (p>0.05) higher in VKA group. DOAC-related ICH was independently (p<0.05) associated with lower likelihood of severe ICH (OR=0.14;95%CI:0.03-0.75), perihematomal edema (OR=0.27;95%CI:0.09-0.81) and adverse 3-month FO (common OR= 0.27;95%CI:0.11-0.68) In multivariable logistic regression analyses adjusting for potential confounders. DOAC-related ICH was independently (p=0.028) related to reduced log-trasformed baseline ICH volume in multiple linear regression analyses adjsuting for demographics, risk factors, HAS-BLED & CHA2DS2-VASc scores, ICH location and concomittant medications.
Conclusion: DOAC-related ICHs appear to have more favorable neuroimaging profile and functional outcome compared to VKA-related ICHs.
Author Disclosures: G. Tsivgoulis: Research Grant; Modest; European Regional Development Fund - Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123). N. Goyal: None. C. Krogias: None. A.H. Katsanos: None. V.K. Sharma: None. K. Barlinn: None. R. Mikulik: None. S. Giannopoulos: None. A. Pappa: None. E. Dardiotis: None. K. Vadikolias: None. A. Kerro: None. A. Tsantes: None. S. Triantafyllou: None. C. Schroeder: None. V. Lioutas: None. J. Chang: None. A.W. Alexandrov: None. A.V. Alexandrov: Research Grant; Modest; Assisi Foundation, PCORI. Speakers’ Bureau; Modest; Genentech, Inc.
- © 2017 by American Heart Association, Inc.