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. 2021 May 21;10(11):2234.
doi: 10.3390/jcm10112234.

Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants

Jawed Nawabi  1   2   3 , Sarah Elsayed  3 , Andrea Morotti  4 , Anna Speth  5 , Melanie Liu  5 , Helge Kniep  3 , Rosalie McDonough  3 , Gabriel Broocks  3 , Tobias Faizy  6 , Elif Can  1 , Peter B Sporns  3   7 , Jens Fiehler  3 , Bernd Hamm  1 , Tobias Penzkofer  1   3 , Georg Bohner  5 , Frieder Schlunk  2   5 , Uta Hanning  3
Affiliations

Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants

Jawed Nawabi et al. J Clin Med. .

Abstract

Background: There is a need to examine the effects of different types of oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) on perihematomal edema (PHE), which is gaining considerable appeal as a biomarker for secondary brain injury and clinical outcome.

Methods: In a large multicenter approach, computed tomography-derived imaging markers for PHE (absolute PHE, relative PHE (rPHE), edema expansion distance (EED)) were calculated for patients with OAC-ICH and NON-OAC-ICH. Exploratory analysis for non-vitamin-K-antagonist OAC (NOAC) and vitamin-K-antagonists (VKA) was performed. The predictive performance of logistic regression models, employing predictors of poor functional outcome (modified Rankin scale 4-6), was explored.

Results: Of 811 retrospectively enrolled patients, 212 (26.14%) had an OAC-ICH. Mean rPHE and mean EED were significantly lower in patients with OAC-ICH compared to NON-OAC-ICH, p-value 0.001 and 0.007; whereas, mean absolute PHE did not differ, p-value 0.091. Mean EED was also significantly lower in NOAC compared to NON-OAC-ICH, p-value 0.05. Absolute PHE was an independent predictor of poor clinical outcome in NON-OAC-ICH (OR 1.02; 95%CI 1.002-1.028; p-value 0.027), but not in OAC-ICH (p-value 0.45).

Conclusion: Quantitative markers of early PHE (rPHE and EED) were lower in patients with OAC-ICH compared to those with NON-OAC-ICH, with significantly lower levels of EED in NOAC compared to NON-OAC-ICH. Increase of early PHE volume did not increase the likelihood of poor outcome in OAC-ICH, but was independently associated with poor outcome in NON-OAC-ICH. The results underline the importance of etiology-specific treatment strategies. Further prospective studies are needed.

Keywords: anticoagulation; cerebral hemorrhage; computed tomography; edema; outcome prediction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Illustrative examples of patients with spontaneous intracerebral hemorrhage (NON-OAC-ICH) and oral anticoagulation related intracerebral hemorrhage (OAC-ICH). Legend: ICH indicates intracerebral hemorrhage; EED, edema extension distance; NCCT, noncontrast computed tomography, OAC-ICH, OAC related intracerebral hemorrhage; PHE, perihematomal edema; rPHE, relative perihematomal edema; and NON-OAC-ICH, non-oral anticoagulation related intracerebral hemorrhage.
Figure 2
Figure 2
Patient flowchart.
See this image and copyright information in PMC

References

    1. Morotti A., Goldstein J.N. Anticoagulant-associated intracerebral hemorrhage. Brain Hemorrhages. 2020;1:89–94. doi: 10.1016/j.hest.2020.01.001. - DOI
    1. Kuramatsu J.B., Sembill J.A., Huttner H.B. Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage. Crit. Care. 2019;23:206. doi: 10.1186/s13054-019-2492-8. - DOI - PMC - PubMed
    1. Cervera A., Amaro S., Chamorro A. Oral anticoagulant-associated intracerebral hemorrhage. J. Neurol. 2012;259:212–224. doi: 10.1007/s00415-011-6153-3. - DOI - PubMed
    1. Feigin V.L., Lawes C.M., Bennett D.A., Anderson C.S. Stroke epidemiology: A review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2:43–53. doi: 10.1016/S1474-4422(03)00266-7. - DOI - PubMed
    1. Venkatasubramanian C., Mlynash M., Finley-Caulfield A., Eyngorn I., Kalimuthu R., Snider R.W., Wijman C.A. Natural History of Perihematomal Edema After Intracerebral Hemorrhage Measured by Serial Magnetic Resonance Imaging. Stroke. 2011;42:73–80. doi: 10.1161/STROKEAHA.110.590646. - DOI - PMC - PubMed

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