%O This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
%X OBJECTIVE: Whether intracerebral haemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin-K antagonists (VKA-ICH) is uncertain. METHODS: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariable regression analyses adjusted for age, sex, ICH location and intraventricular haemorrhage extension. RESULTS: We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age:77 years,52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs. 26.5%; HR=0.94, 95%CI: 0.67 to 1.31). However, in multivariable analyses adjusting for potential confounders, NOAC-ICH was associated with: lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient=-2.83, 95%CI:-5.28 to -0.38); lower likelihood of severe stroke (NIHSS>10 points) on admission (OR=0.50, 95%CI: 0.30 to 0.84); and smaller baseline haematoma volume (linear regression coefficient=-0.24,95%CI:-0.47 to -0.16). The two groups did not differ in the likelihood of: baseline haematoma volume less than 30cm3 (OR=1.14, 95%CI: 0.81 to 1.62); haematoma expansion (OR=0.97, 95%CI: 0.63 to 1.48); in-hospital mortality (OR=0.73,95%CI: 0.49 to 1.11); functional status at discharge (common OR=0.78, 95%CI: 0.57 to 1.07); or functional status at three months (common OR=1.03, 95%CI: 0.75 to 1.43). INTERPRETATION: Although functional outcome at discharge, one month or three months were comparable after NOAC-ICH and VKA-ICH, patients with NOAC-ICH had smaller baseline haematoma volumes and less severe acute stroke syndromes.
%C United States
%L discovery10057877
%K haematoma volume, individual patient data meta-analysis, intracerebral haemorrhage, non-vitamin K antagonist, outcome, vitamin K antagonist
%J Annals of Neurology
%D 2018
%P 694-704
%N 5
%V 84
%A G Tsivgoulis
%A D Wilson
%A AH Katsanos
%A J Sargento-Freitas
%A C Marques-Matos
%A E Azevedo
%A T Adachi
%A C von der Brelie
%A Y Aizawa
%A H Abe
%A H Tomita
%A K Okumura
%A J Hagii
%A DJ Seiffge
%A V-A Lioutas
%A C Traenka
%A P Varelas
%A G Basir
%A C Krogias
%A JC Purrucker
%A VK Sharma
%A T Rizos
%A R Mikulik
%A OA Sobowale
%A K Barlinn
%A H Sallinen
%A N Goyal
%A S-J Yeh
%A T Karapanayiotides
%A TY Wu
%A K Vadikolias
%A M Ferrigno
%A G Hadjigeorgiou
%A R Houben
%A S Giannopoulos
%A FHBM Schreuder
%A JJ Chang
%A LA Perry
%A M Mehdorn
%A J-P Marto
%A J Pinho
%A J Tanaka
%A M Boulanger
%A RA-S Salman
%A HR Jäger
%A C Shakeshaft
%A Y Yakushiji
%A PMC Choi
%A J Staals
%A C Cordonnier
%A J-S Jeng
%A R Veltkamp
%A D Dowlatshahi
%A ST Engelter
%A AR Parry-Jones
%A A Meretoja
%A P Mitsias
%A AV Alexandrov
%A G Ambler
%A DJ Werring
%T Neuroimaging and clinical outcomes of oral anticoagulant associated ICH