Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment
Apostolaki-Hansson, Trine LU
; Ullberg, Teresa
LU
; Norrving, Bo
LU
and Petersson, Jesper
LU
(2019)
In Acta Neurologica Scandinavica
139(5).
p.415-421
- Abstract
Background: Intracerebral hemorrhage (ICH) is the most serious adverse effect of treatment with oral anticoagulants. Prognostic data after ICH associated with non-vitamin K antagonist oral anticoagulants (NOAC) compared to vitamin K antagonists (VKA) are sparse. We compared 90-day survival and functional outcome following NOAC-ICH versus VKA-ICH using data from the Swedish Stroke Register (Riksstroke). Methods: Using data from Riksstroke and the Swedish Causes of Death Register between 2012 and 2016, we compared all-cause 90-day mortality for patients with NOAC-ICH versus VKA-ICH using Kaplan-Meier survival analysis and Log-rank test. Cox regression, with adjustment for age, sex, previous stroke, and level of consciousness (LOC) on... (More)
Background: Intracerebral hemorrhage (ICH) is the most serious adverse effect of treatment with oral anticoagulants. Prognostic data after ICH associated with non-vitamin K antagonist oral anticoagulants (NOAC) compared to vitamin K antagonists (VKA) are sparse. We compared 90-day survival and functional outcome following NOAC-ICH versus VKA-ICH using data from the Swedish Stroke Register (Riksstroke). Methods: Using data from Riksstroke and the Swedish Causes of Death Register between 2012 and 2016, we compared all-cause 90-day mortality for patients with NOAC-ICH versus VKA-ICH using Kaplan-Meier survival analysis and Log-rank test. Cox regression, with adjustment for age, sex, previous stroke, and level of consciousness (LOC) on admission, was used to estimate hazard ratios (HR) for 90-day mortality. Estimated functional outcome at 90 days, based on the modified Rankin Scale (mRS), was compared between VKA- and NOAC-associated ICH using chi-squared test. Results: We included 2483 patients; 300 with NOAC-ICH and 2183 with VKA-ICH. In both groups, mean age was 79 years, and 58% were male. No significant difference between NOAC-ICH and VKA-ICH was found for all-cause 90-day mortality (44.3% NOAC-ICH versus 42.6% VKA-ICH; P = 0.54, HR = 0.93; 95% confidence interval (CI): 0.78-1.12) or 90-day estimated functional outcome (mRS 0-2:13.7% and 15.3%; mRS 3-5:27.3% and 28.9%, respectively (P = 0.52)). Factors predicting death were increased age (HR = 1.03; 95%CI: 1.02-1.04) and reduced LOC (drowsy: HR = 3.48; 95%CI: 2.86-4.23; comatose: HR = 12.27; 95%CI: 10.13-14.87). Conclusion: In this large study on anticoagulant-associated ICH, we found no significant difference in mortality and functional outcome at 90 days between NOAC-ICH versus VKA-ICH.
(Less)
- author
- Apostolaki-Hansson, Trine
LU
; Ullberg, Teresa
LU
; Norrving, Bo
LU
and Petersson, Jesper
LU
- organization
- publishing date
- 2019-01-18
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Acta Neurologica Scandinavica
- volume
- 139
- issue
- 5
- pages
- 415 - 421
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85061581358
- pmid:30657164
- ISSN
- 0001-6314
- DOI
- 10.1111/ane.13068
- language
- English
- LU publication?
- yes
- id
- 1c634a0c-7daf-4d6d-aab7-f4594082d933
- date added to LUP
- 2019-03-15 11:28:05
- date last changed
- 2024-06-26 11:06:47
@article{1c634a0c-7daf-4d6d-aab7-f4594082d933,
abstract = {{<p>Background: Intracerebral hemorrhage (ICH) is the most serious adverse effect of treatment with oral anticoagulants. Prognostic data after ICH associated with non-vitamin K antagonist oral anticoagulants (NOAC) compared to vitamin K antagonists (VKA) are sparse. We compared 90-day survival and functional outcome following NOAC-ICH versus VKA-ICH using data from the Swedish Stroke Register (Riksstroke). Methods: Using data from Riksstroke and the Swedish Causes of Death Register between 2012 and 2016, we compared all-cause 90-day mortality for patients with NOAC-ICH versus VKA-ICH using Kaplan-Meier survival analysis and Log-rank test. Cox regression, with adjustment for age, sex, previous stroke, and level of consciousness (LOC) on admission, was used to estimate hazard ratios (HR) for 90-day mortality. Estimated functional outcome at 90 days, based on the modified Rankin Scale (mRS), was compared between VKA- and NOAC-associated ICH using chi-squared test. Results: We included 2483 patients; 300 with NOAC-ICH and 2183 with VKA-ICH. In both groups, mean age was 79 years, and 58% were male. No significant difference between NOAC-ICH and VKA-ICH was found for all-cause 90-day mortality (44.3% NOAC-ICH versus 42.6% VKA-ICH; P = 0.54, HR = 0.93; 95% confidence interval (CI): 0.78-1.12) or 90-day estimated functional outcome (mRS 0-2:13.7% and 15.3%; mRS 3-5:27.3% and 28.9%, respectively (P = 0.52)). Factors predicting death were increased age (HR = 1.03; 95%CI: 1.02-1.04) and reduced LOC (drowsy: HR = 3.48; 95%CI: 2.86-4.23; comatose: HR = 12.27; 95%CI: 10.13-14.87). Conclusion: In this large study on anticoagulant-associated ICH, we found no significant difference in mortality and functional outcome at 90 days between NOAC-ICH versus VKA-ICH.</p>}},
author = {{Apostolaki-Hansson, Trine and Ullberg, Teresa and Norrving, Bo and Petersson, Jesper}},
issn = {{0001-6314}},
language = {{eng}},
month = {{01}},
number = {{5}},
pages = {{415--421}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Neurologica Scandinavica}},
title = {{Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment}},
url = {{http://dx.doi.org/10.1111/ane.13068}},
doi = {{10.1111/ane.13068}},
volume = {{139}},
year = {{2019}},
}