Clinical and radiological course of intracerebral haemorrhage associated with the new non-vitamin K anticoagulants.
BACKGROUND
Clinical outcome and mortality in intracerebral haemorrhage (ICH) associated with anticoagulant treatment is poor. Novel direct oral anticoagulant drugs (NOACs) are increasingly prescribed. Management of NOAC-associated ICH might be more challenging. The aim of this study was to compare the clinical and radiological course of ICH patients being treated with different forms of oral anticoagulant drugs.


METHOD
The study is a retrospective observational study. Haemorrhage in other intracranial compartments except the ventricular system were explicitly excluded. Four groups were categorised and compared with regard to their clinical and radiological course (NOACs, vitamin K antagonists [VKAs], platelet inhibitors and patients without anticoagulant/antiplatelet drugs). Clinical as well as radiological parameters were analysed.


RESULTS
Overall, 182 patients were included (2011 to early 2016). Twenty-five patients with NOAC-associated ICH were included (47 with VKAs, 50 with platelet inhibitors and 60 patients without anticoagulant/antiplatelet drugs). The frequency of NOAC-associated ICH increased over the years. Diabetes was found significantly more often in the NOAC patients (p = 0.05). The clinical and radiological courses in the three different patient groups with impaired coagulation were similar. Mortality was significantly higher in patient groups with impaired coagulation (p = 0.04) compared to those without anticoagulant/antiplatelet drugs. Multivariate analysis revealed the Glasgow Coma Scale (GCS) score as a strong predictor for worse outcome and mortality.


CONCLUSIONS
The frequency of NOAC-associated ICH increased in the last 5 years. Diabetes might be a risk factor for ICH when receiving NOACs. Clinical outcome in NOAC-associated ICH is poor and mortality is as high as in patients with other oral anticoagulant/antiplatelet drugs.
['von der Brelie|Christian|C|', 'Doukas|Alexandros|A|', 'Naumann|Rebecca|R|', 'Dempfle|Astrid|A|', 'Larsen|Naomi|N|', 'Synowitz|Michael|M|', 'Jansen|Olav|O|', 'Mehdorn|Maximilian|M|', 'Jadik|Senol|S|']
D000368:Aged D000369:Aged, 80 and over D000925:Anticoagulants D002543:Cerebral Hemorrhage D005260:Female D015600:Glasgow Coma Scale D006801:Humans D008297:Male D008875:Middle Aged D010975:Platelet Aggregation Inhibitors D012189:Retrospective Studies D014812:Vitamin K
Outcome Clinical management Intracerebal haemorrhage Novel anticoagulant drug Surgical treatment