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Brief Report

Characteristics of Intracerebral Hemorrhage During Rivaroxaban Treatment

Comparison With Those During Warfarin

Joji Hagii, Hirofumi Tomita, Norifumi Metoki, Shin Saito, Hiroshi Shiroto, Hiroyasu Hitomi, Takaatsu Kamada, Satoshi Seino, Koki Takahashi, Yoshiko Baba, Satoko Sasaki, Takamitsu Uchizawa, Manabu Iwata, Shigeo Matsumoto, Tomohiro Osanai, Minoru Yasujima, Ken Okumura
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https://doi.org/10.1161/STROKEAHA.114.006661
Stroke. 2014;STROKEAHA.114.006661
Originally published July 31, 2014
Joji Hagii
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Hirofumi Tomita
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Norifumi Metoki
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Shin Saito
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Hiroshi Shiroto
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Hiroyasu Hitomi
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Takaatsu Kamada
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Satoshi Seino
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Koki Takahashi
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Yoshiko Baba
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Satoko Sasaki
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Takamitsu Uchizawa
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Manabu Iwata
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Shigeo Matsumoto
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Tomohiro Osanai
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Minoru Yasujima
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Ken Okumura
From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Abstract

Background and Purpose—Neuroradiological characteristics and functional outcomes of patients with intracerebral hemorrhage (ICH) during novel oral anticoagulant treatment were not well defined. We examined these in comparison with those during warfarin treatment.

Methods—The consecutive 585 patients with ICH admitted from April 2011 through October 2013 were retrospectively studied. Of all, 5 patients (1%) had ICH during rivaroxaban treatment, 56 (10%) during warfarin, and the other 524 (89%) during no anticoagulants. We focused on ICH during rivaroxaban and warfarin treatments and compared the clinical characteristics, neuroradiological findings, and functional outcomes.

Results—Patients in the rivaroxaban group were all at high risk for major bleeding with hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS-BLED) score of 3 and higher rate of past history of ICH. Moreover, multiple cerebral microbleeds (≥4) were detected more frequently in rivaroxaban group than in warfarin (80% versus 29%; P=0.04). Hematoma volume in rivaroxaban group was markedly smaller than that in warfarin (median: 4 versus 11 mL; P=0.03). No patient in the rivaroxaban group had expansion of hematoma and surgical treatment. Rivaroxaban group showed lower modified Rankin Scale at discharge relative to warfarin, and the difference between modified Rankin Scale before admission and at discharge was smaller in rivaroxaban than in warfarin (median: 1 versus 3; P=0.047). No patient in the rivaroxaban group died during hospitalization, whereas 10 (18%) warfarin patients died.

Conclusions—Rivaroxaban-associated ICH occurs in patients at high risk for major bleeding. However, they had a relatively small hematoma, no expansion of hematoma, and favorable functional and vital outcomes compared with warfarin-associated ICH.

  • atrial fibrillation
  • intracranial hemorrhages
  • rivaroxaban
  • Received July 3, 2014.
  • Accepted July 14, 2014.
  • © 2014 American Heart Association, Inc.

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    Characteristics of Intracerebral Hemorrhage During Rivaroxaban Treatment
    Joji Hagii, Hirofumi Tomita, Norifumi Metoki, Shin Saito, Hiroshi Shiroto, Hiroyasu Hitomi, Takaatsu Kamada, Satoshi Seino, Koki Takahashi, Yoshiko Baba, Satoko Sasaki, Takamitsu Uchizawa, Manabu Iwata, Shigeo Matsumoto, Tomohiro Osanai, Minoru Yasujima and Ken Okumura
    Stroke. 2014;STROKEAHA.114.006661, originally published July 31, 2014
    https://doi.org/10.1161/STROKEAHA.114.006661

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    Characteristics of Intracerebral Hemorrhage During Rivaroxaban Treatment
    Joji Hagii, Hirofumi Tomita, Norifumi Metoki, Shin Saito, Hiroshi Shiroto, Hiroyasu Hitomi, Takaatsu Kamada, Satoshi Seino, Koki Takahashi, Yoshiko Baba, Satoko Sasaki, Takamitsu Uchizawa, Manabu Iwata, Shigeo Matsumoto, Tomohiro Osanai, Minoru Yasujima and Ken Okumura
    Stroke. 2014;STROKEAHA.114.006661, originally published July 31, 2014
    https://doi.org/10.1161/STROKEAHA.114.006661
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