Early Clinical and Radiological Course, Management, and Outcome of XXXX Related to New Oral Anticoagulants.

@entity1 @entity64 @entity548 @entity2067 @entity1410 @entity1779
Importance: @entity1779 ( @entity1779 ) is the most devastating adverse event in @entity1 receiving oral anticoagulation. There is only sparse evidence regarding @entity1779 related to the use of non- @entity2067 antagonist oral anticoagulant (NOAC) agents. Objective: To evaluate the early clinical and radiological course, acute management, and outcome of @entity1779 related to NOAC use. Design, Setting, and @entity1 : Prospective investigator-initiated, multicenter observational study. All diagnostic and treatment decisions, including administration of hemostatic factors (eg, prothrombin complex concentrate), were left to the discretion of the treating physicians. The setting was 38 @entity64 units across Germany (February 1, 2012, to December 31, 2014). The study included 61 consecutive @entity1 with nontraumatic NOAC-associated @entity1779 , of whom 45 (74%) qualified for the @entity1410 expansion analysis. Main Outcomes and Measures: @entity1410 expansion, @entity548 , and reversal of anticoagulation during the acute phase. Recorded were the 3-month functional outcome, factors associated with an unfavorable outcome (modified Rankin Scale score, 3-6), any new intraventricular extension or an increase in the modified Graeb score by at least 2 points, and the frequency of substantial @entity1410 expansion (defined as relative [>= 33%] or absolute [>= 6-mL] volume increase). Results: In total, 41% (25 of 61) of @entity1 with NOAC-associated @entity1779 were female, and the mean (SD) @entity1 age was 76.1 (11.6) years. At admission, the median National Institutes of Health Stroke Scale score was 10 (interquartile range, 4-18). The mean (SD) baseline @entity1410 volume was 23.7 (31.3) mL. In @entity1 with sequential imaging for the @entity1410 expansion analysis, substantial @entity1410 expansion occurred in 38% (17 of 45). New or @entity548 was observed in 18% (8 of 45). Overall mortality was 28% (17 of 60 [follow-up data were missing in 1 @entity1 ]) at 3 months, and 65% (28 of 43) of survivors had an unfavorable outcome (modified Rankin Scale score, 3-6). Overall, 57% (35 of 61) of the @entity1 received prothrombin complex concentrate, with no statistically significant effect on the frequency of substantial @entity1410 expansion (43% [12 of 28] for prothrombin complex concentrate vs 29% [5 of 17] for no prothrombin complex concentrate, P   =   .53), or on the occurrence of an unfavorable outcome (modified Rankin Scale score, 3-6) (odds ratio, 1.20; 95% CI, 0.37-3.87; P   =   .76). Conclusions and Relevance: Non- @entity2067 antagonist oral anticoagulant-associated @entity1779 has a high mortality and an unfavorable outcome, and @entity1410 expansion is frequent. Larger-scale prospective studies are needed to determine whether the early administration of specific antidotes can improve the poor prognosis of NOAC-associated @entity1779 .
