Observational Study

. 2016 Jan 26;86(4):360-6.

doi: 10.1212/WNL.0000000000002310. Epub 2015 Dec 30.

Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type

Collaborators, Affiliations

Collaborators

CROMIS-2 collaborators:
Louise Shaw, Jane Sword, Azlisham Mohd, Pankaj Sharma, Deborah Kelly, Frances Harrington, Marc Randall, Matthew Smith, Karim Mahawish, Abduelbaset Elmarim, Bernard Esisi, Claire Cullen, Arumug Nallasivam, Christopher Price, Adrian Barry, Christine Roffe, John Coyle, Ahamad Hassan, Caroline Lovelock, Jonathan Birns, David Cohen, L Sekaran, Adrian Parry-Jones, Anthea Parry, David Hargroves, Harald Proschel, Prabel Datta, Khaled Darawil, Aravindakshan Manoj, Mathew Burn, Chris Patterson, Elio Giallombardo, Nigel Smyth, Syed Mansoor, Ijaz Anwar, Rachel Marsh, Sissi Ispoglou, Dinesh Chadha, Mathuri Prabhakaran, Sanjeevikumar Meenakishundaram, Janice O'Connell, Jon Scott, Vinodh Krishnamurthy, Prasanna Aghoram, Michael McCormick, Paul O'Mahony, Martin Cooper, Lillian Choy, Peter Wilkinson, Simon Leach, Sarah Caine, Ilse Burger, Gunaratam Gunathilagan, Paul Guyler, Hedley Emsley, Michelle Davis, Dulka Manawadu, Kath Pasco, Maam Mamun, Robert Luder, Mahmud Sajid, Ijaz Anwar, James Okwera, Julie Staals, Elizabeth Warburton, Kari Saastamoinen, Timothy England, Janet Putterill, Enrico Flossman, Michael Power, Krishna Dani, David Mangion, Appu Suman, John Corrigan, Enas Lawrence, Djamil Vahidassr

Affiliations

¹ From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
² From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK. d.werring@ucl.ac.uk.

PMID: 26718576
PMCID: PMC4776084
DOI: 10.1212/WNL.0000000000002310

Observational Study

Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type

Duncan Wilson et al. Neurology. 2016.

. 2016 Jan 26;86(4):360-6.

doi: 10.1212/WNL.0000000000002310. Epub 2015 Dec 30.

Collaborators

CROMIS-2 collaborators:
Louise Shaw, Jane Sword, Azlisham Mohd, Pankaj Sharma, Deborah Kelly, Frances Harrington, Marc Randall, Matthew Smith, Karim Mahawish, Abduelbaset Elmarim, Bernard Esisi, Claire Cullen, Arumug Nallasivam, Christopher Price, Adrian Barry, Christine Roffe, John Coyle, Ahamad Hassan, Caroline Lovelock, Jonathan Birns, David Cohen, L Sekaran, Adrian Parry-Jones, Anthea Parry, David Hargroves, Harald Proschel, Prabel Datta, Khaled Darawil, Aravindakshan Manoj, Mathew Burn, Chris Patterson, Elio Giallombardo, Nigel Smyth, Syed Mansoor, Ijaz Anwar, Rachel Marsh, Sissi Ispoglou, Dinesh Chadha, Mathuri Prabhakaran, Sanjeevikumar Meenakishundaram, Janice O'Connell, Jon Scott, Vinodh Krishnamurthy, Prasanna Aghoram, Michael McCormick, Paul O'Mahony, Martin Cooper, Lillian Choy, Peter Wilkinson, Simon Leach, Sarah Caine, Ilse Burger, Gunaratam Gunathilagan, Paul Guyler, Hedley Emsley, Michelle Davis, Dulka Manawadu, Kath Pasco, Maam Mamun, Robert Luder, Mahmud Sajid, Ijaz Anwar, James Okwera, Julie Staals, Elizabeth Warburton, Kari Saastamoinen, Timothy England, Janet Putterill, Enrico Flossman, Michael Power, Krishna Dani, David Mangion, Appu Suman, John Corrigan, Enas Lawrence, Djamil Vahidassr

Affiliations

¹ From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
² From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK. d.werring@ucl.ac.uk.

PMID: 26718576
PMCID: PMC4776084
DOI: 10.1212/WNL.0000000000002310

Abstract

Objective: To compare intracerebral hemorrhage (ICH) volume and clinical outcome of non-vitamin K oral anticoagulants (NOAC)-associated ICH to warfarin-associated ICH.

Methods: In this multicenter cross-sectional observational study of patients with anticoagulant-associated ICH, consecutive patients with NOAC-ICH were compared to those with warfarin-ICH selected from a population of 344 patients with anticoagulant-associated ICH. ICH volume was measured by an observer blinded to clinical details. Outcome measures were ICH volume and clinical outcome adjusted for confounding factors.

Results: We compared 11 patients with NOAC-ICH to 52 patients with warfarin-ICH. The median ICH volume was 2.4 mL (interquartile range [IQR] 0.3-5.4 mL) for NOAC-ICH vs 8.9 mL (IQR 4.0-21.3 mL) for warfarin-ICH (p = 0.0028). In univariate linear regression, use of warfarin (difference in cube root volume 1.61; 95% confidence interval [CI] 0.69 to 2.53) and lobar ICH location (compared with nonlobar ICH; difference in cube root volume 1.52; 95% CI 2.20 to 0.85) were associated with larger ICH volumes. In multivariable linear regression adjusting for confounding factors (sex, hypertension, previous ischemic stroke, white matter disease burden, and premorbid modified Rankin Scale score [mRS]), warfarin use remained independently associated with larger ICH (cube root) volumes (coefficient 0.64; 95% CI 0.24 to 1.25; p = 0.042). Ordered logistic regression showed an increased odds of a worse clinical outcome (as measured by discharge mRS) in warfarin-ICH compared with NOAC-ICH: odds ratio 4.46 (95% CI 1.10 to 18.14; p = 0.037).

Conclusions: In this small prospective observational study, patients with NOAC-associated ICH had smaller ICH volumes and better clinical outcomes compared with warfarin-associated ICH.

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Figures

**Figure 1. Flow chart of study design and patient selection**
ICH = intracerebral hemorrhage; NOAC = non–vitamin K oral anticoagulant; SAH = subarachnoid hemorrhage.

**Figure 2. Dot plot and box plot**
(A) Dot plot of individual participants and their corresponding hemorrhage sizes. Blue dots show warfarin–intracerebral hemorrhage (ICH); red triangles show non–vitamin K oral anticoagulant (NOAC)–ICH. (B) Box plot shows median, lower and upper quartiles, and minimum and maximum values of hematoma volume for NOAC-ICH cases and warfarin-ICH cases.

See this image and copyright information in PMC

References

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Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type

Collaborators

Affiliations

Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type

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