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Multicenter Study
. 2021 Jan;16(1):83-92.
doi: 10.1177/1747493019895662. Epub 2019 Dec 23.

Age-dependent clinical outcomes in primary versus oral anticoagulation-related intracerebral hemorrhage

Maximilian I Sprügel  1 , Joji B Kuramatsu  1 , Stefan T Gerner  1 , Jochen A Sembill  1 , Dominik Madžar  1 , Caroline Reindl  1 , Tobias Bobinger  1 , Tamara Müller  1 , Philip Hoelter  2 , Hannes Lücking  2 , Tobias Engelhorn  2 , Hagen B Huttner  1
Affiliations
Multicenter Study

Age-dependent clinical outcomes in primary versus oral anticoagulation-related intracerebral hemorrhage

Maximilian I Sprügel et al. Int J Stroke. 2021 Jan.

Abstract

Aims: This study determined the influence of age on bleeding characteristics and clinical outcomes in primary spontaneous (non-OAC), vitamin K antagonist-related (VKA-) and non-vitamin K antagonist oral anticoagulant-related (NOAC-) ICH.

Methods: Pooled individual patient data of multicenter cohort studies were analyzed by logistic regression modelling and propensity-score-matching (PSM) to explore the influence of advanced age on clinical outcomes among non-OAC-, VKA-, and NOAC-ICH. Primary outcome measure was functional outcome at three months assessed by the modified Rankin Scale, dichotomized into favorable (mRS = 0-3) and unfavorable (mRS = 4-6) functional outcome. Secondary outcome measures included mortality, hematoma characteristics, and frequency of invasive interventions.

Results: In VKA-ICH 33.5% (670/2001), in NOAC-ICH 44.2% (69/156) and in non-OAC-ICH 25.2% (254/1009) of the patients were ≥80 years. After adjustment for treatment interventions and relevant parameters, elderly ICH patients comprised worse functional outcome at three months (adjusted odds ratio (aOR) in VKA-ICH: 1.49 (1.21-1.84); p < 0.001; NOAC-ICH: 2.01 (0.95-4.26); p = 0.069; non-OAC-ICH: 3.54 (2.50-5.03); p < 0.001). Anticoagulation was significantly associated with worse functional outcome below the age of 70 years, (aOR: 2.38 (1.78-3.16); p < 0.001), but not in patients of ≥70 years (aOR: 1.21 (0.89-1.65); p = 0.217). The differences in initial ICH volume and extent of ICH enlargement between OAC-ICH and non-OAC-ICH gradually decreased with increasing patient age.

Conclusions: As compared to elderly ICH-patients, in patients <70 years OAC-ICH showed worse clinical outcomes compared to non-OAC-ICH because of larger baseline ICH-volumes and extent of hematoma enlargement. Treatment strategies aiming at neutralizing altered coagulation should be aware of these findings.

Keywords: Intracerebral hemorrhage; age; anticoagulation; intracranial hemorrhage.

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