Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, metaanalýza
Grantová podpora
CS/18/2/33719
British Heart Foundation - United Kingdom
R380R/1114
The Dunhill Medical Trust - United Kingdom
PubMed
30255970
DOI
10.1002/ana.25342
Knihovny.cz E-zdroje
- MeSH
- antikoagulancia aplikace a dávkování škodlivé účinky MeSH
- aplikace orální MeSH
- cerebrální krvácení chemicky indukované mortalita patologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurozobrazování MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vitamin K antagonisté a inhibitory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- Názvy látek
- antikoagulancia MeSH
- vitamin K MeSH
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.
CEDOC Nova Medical School New University of Lisbon Lisbon Portugal
Department of Neurology and General Internal Medicine Tokyo Saiseikai Central Hospital Tokyo Japan
Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
Department of Neurology Braga Hospital Braga Portugal
Department of Neurology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
Department of Neurology Christchurch Hospital Christchurch New Zealand
Department of Neurology Democritus University of Thrace Alexandroupolis Greece
Department of Neurology Dresden Neurovascular Center Dresden Germany
Department of Neurology Heidelberg University Hospital Heidelberg Germany
Department of Neurology Helsinki University Hospital Helsinki Finland
Department of Neurology Henry Ford Hospital Detroit MI
Department of Neurology Maastricht University Medical Center Maastricht the Netherlands
Department of Neurology São João University Hospital Center Porto Portugal
Department of Neurology School of Medicine University of Crete Crete Greece
Department of Neurology St Josef Hospital Ruhr University Bochum Bochum Germany
Department of Neurology University of Ioannina School of Medicine Ioannina Greece
Department of Neurology University of Tennessee Health Science Center Memphis TN
Department of Neurology University of Thessaly Larissa Greece
Department of Neurosciences Eastern Health Melbourne Victoria Australia
Department of Neurosurgery Georg August University of Göttingen Göttingen Germany
Department of Research and Development Tachikawa Medical Center Nagaoka Japan
Department of Statistical Science University College London London United Kingdom
Division of Brain Sciences Department of Stroke Medicine Imperial College London United Kingdom
Division of Neurology Department of Internal Medicine Faculty of Medicine Saga University Saga Japan
Division of Neurology Yong Loo Lin School of Medicine National University of Singapore Singapore
Faculty of Medicine University of Coimbra Coimbra Portugal
Hirosaki Stroke and Rehabilitation Center Hirosaki Japan
Neurology Department Egas Moniz Hospital West Lisbon Hospital Center Lisbon Portugal
Ottawa Hospital Research Institute and University of Ottawa Ottawa Ontario Canada
Stroke Center and Department of Neurology National Taiwan University Hospital Taiwan
Stroke Center and Neurology University Hospital and University of Basel Basel Switzerland
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