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Neuroimaging and clinical outcomes of oral anticoagulant associated ICH.

A new interesting article has been published in Ann Neurol. 2018 Sep 26. doi: 10.1002/ana.25342. and titled:

Neuroimaging and clinical outcomes of oral anticoagulant associated ICH.

Authors of this article are:
Tsivgoulis G Wilson D Katsanos AH Sargento-Freitas J Marques-Matos C Azevedo E Adachi T von der Brelie C0 Aizawa Y Abe H Tomita H Okumura K Hagii J Seiffge DJ Lioutas VA Traenka C Varelas P Basir G Krogias C Purrucker JC0 Sharma VK Rizos T0 Mikulik R Sobowale OA Barlinn K Sallinen H Goyal N Yeh SJ Karapanayiotides T Wu TY Vadikolias K Ferrigno M0 Hadjigeorgiou G Houben R Giannopoulos S Schreuder FHBM Chang JJ Perry LA Mehdorn M0 Marto JP Pinho J Tanaka J Boulanger M Salman RA Jäger HR0 Shakeshaft C Yakushiji Y Choi PMC Staals J Cordonnier C0 Jeng JS Veltkamp R Dowlatshahi D Engelter ST Parry-Jones AR Meretoja A Mitsias P Alexandrov AV Ambler G Werring DJ.

A summary of the article is shown below:
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. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.

Check out the article’s website on Pubmed for more information:

This article is a good source of information and a good way to become familiar with topics such as: haematoma volume;individual patient data meta-analysis;intracerebral haemorrhage;non-vitamin K antagonist;outcome;vitamin K antagonist.

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