학술논문

Intracerebral haemorrhage in patients taking different types of oral anticoagulants: a pooled individual patient data analysis from two national stroke registries.
Document Type
Academic Journal
Author
Siepen BM; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.; Forfang E; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.; Branca M; CTU Bern, Department of Clinical Research, University of Bern, Bern, Switzerland.; Drop B; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Mueller M; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Goeldlin MB; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Katan M; Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.; Michel P; Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.; Cereda C; Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano, Switzerland.; Medlin F; Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital, Fribourg, Switzerland.; Peters N; Stroke Center Hirslanden, Klinik Hirslanden Zurich, Zurich, Switzerland.; Renaud S; Division of Neurology, Pourtalès Hospital, Neuchatel, Switzerland.; Niederhauser J; Stroke Unit, GHOL, Hospital Nyon, Nyon, Switzerland.; Carrera E; Stroke Research Group, Department of Clinical Neurosciences, Geneva University Hospital, Faculty of Medicine, University of Geneva, Geneva, Switzerland.; Kahles T; Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.; Kägi G; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.; Bolognese M; Neurology Department, Lucerne Cantonal Hospital (LUKS), Luzern, Switzerland.; Salmen S; Stroke Unit, Department of Neurology, Hospital Biel, Biel, Switzerland.; Mono ML; Department of Neurology, Stadtspitäler Triemli und Waid, Zurich, Switzerland.; Polymeris AA; Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.; Wegener S; Department of Neurology and Stroke Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.; Z'Graggen W; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland.; Kaesmacher J; University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Schaerer M; Department of Neurology, Bürgerspital Solothurn, Solothurn, Switzerland.; Rodic B; Stroke Unit, Department of Neurology, Cantonal Hospital Winterthur, Winterthur, Switzerland.; Kristoffersen ES; Department of Neurology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.; Department of General Practice, University of Oslo, Oslo, Norway.; Larsen KT; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.; Department of Neurology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.; Wyller TB; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.; Volbers B; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Meinel TR; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Arnold M; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Engelter ST; Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.; Department of Neurology and Neurorehabilitation, University of Basel; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland.; Bonati LH; Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.; Rehabilitation Clinic Rheinfelden, Rheinfelden, Switzerland.; Fischer U; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.; Rønning OM; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Neurology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.; Seiffge DJ; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland david.seiffge@insel.ch.
Source
Publisher: BMJ Country of Publication: England NLM ID: 101689996 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2059-8696 (Electronic) Linking ISSN: 20598688 NLM ISO Abbreviation: Stroke Vasc Neurol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: We investigated outcomes in patients with intracerebral haemorrhage (ICH) according to prior anticoagulation treatment with Vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs) or no anticoagulation.
Methods: This is an individual patient data study combining two prospective national stroke registries from Switzerland and Norway (2013-2019). We included all consecutive patients with ICH from both registries. The main outcomes were favourable functional outcome (modified Rankin Scale 0-2) and mortality at 3 months.
Results: Among 11 349 patients with ICH (mean age 73.6 years; 47.6% women), 1491 (13.1%) were taking VKAs and 1205 (10.6%) DOACs (95.2% factor Xa inhibitors). The median percentage of patients on prior anticoagulation was 23.7 (IQR 22.6-25.1) with VKAs decreasing (from 18.3% to 7.6%) and DOACs increasing (from 3.0% to 18.0%) over time. Prior VKA therapy (n=209 (22.3%); adjusted ORs (aOR), 0.64; 95% CI, 0.49 to 0.84) and prior DOAC therapy (n=184 (25.7%); aOR, 0.64; 95% CI, 0.47 to 0.87) were independently associated with lower odds of favourable outcome compared with patients without anticoagulation (n=2037 (38.8%)). Prior VKA therapy (n=720 (49.4%); aOR, 1.71; 95% CI, 1.41 to 2.08) and prior DOAC therapy (n=460 (39.7%); aOR, 1.28; 95% CI, 1.02 to 1.60) were independently associated with higher odds of mortality compared with patients without anticoagulation (n=2512 (30.2%)).
Conclusions: The spectrum of anticoagulation-associated ICH changed over time. Compared with patients without prior anticoagulation, prior VKA treatment and prior DOAC treatment were independently associated with lower odds of favourable outcome and higher odds of mortality at 3 months. Specific reversal agents unavailable during the study period might improve outcomes of DOAC-associated ICH in the future.
Competing Interests: Competing interests: MBo: personal fees from AstraZeneca, a company that produces Andexanet alfa (a specific reversal agent for factor Xa-inhibitor-associated ICH, discussed in this study). SW: consultancy fees from Bayer, a company that produces Rivaroxaban (a DOAC discussed in this study). BV: personal fees from Pfizer AG/Bristol-Myers Squibb SA and Bayer AG, producesr of Apixaban and Rivaroxaban, two drugs discussed in this study. DJS: grants from Alexion/AstraZeneca, producer of andexanet alfa discussed in this study. Personal fees from Bayer, producer of Rivaroxaban, discussed in this study. Consultancy fees from VarmX (producer of VarmX, a compound under development for the treatment of FXaI-associated bleeding). All other authors have nothing to disclose.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)