INTRACEREBRAL HEMORRHAGE AND THE USE OF VARIOUS TYPES OF ANTICOAGULANTS – CLINICAL PRESENTATION AND TREATMENT OUTCOMES
Abstract
Introduction: Anticoagulant therapy plays a key role in the prevention and treatment of various vascular diseases, but it simultaneously increases the risk of hemorrhagic complications, including intracerebral hemorrhage (ICH). This study aimed to examine the outcomes of patients with ICH based on prior anticoagulant therapy.
Methods: This was a retrospective cohort study involving 37 out of 277 patients with ICH from the hospital registry treated between January and November 2024 at the Special Hospital for Cerebrovascular Diseases "Sveti Sava". All patients were divided into two groups: those treated with vitamin K antagonists (VKA) or direct oral anticoagulants (NOAC). The treatment outcome of patients at discharge and 90 days after discharge was determined using the modified Rankin Scale (mRS).
Results: In the group of patients previously treated with VKA, the mean mRS score at discharge was 4.6 ± 1.8, while in the group previously treated with NOAC therapy, it was 5.1 ± 1.7, with no statistically significant difference between the groups (p = 0.442). Additionally, no statistical significance was found in the mRS 90 days after discharge (p = 0.341). In the VKA-ICH group, the mean value was 4.3 ± 2.2, while in the other group, it was 4.9 ± 2. In the first group, the mortality rate was 58%, while in the second group, it was 76%.
Conclusion: Patients with ICH and prior VKA therapy showed no significant differences in treatment outcomes compared to patients with prior NOAC therapy.
References
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021 Oct;20(10):795-820. doi: 10.1016/S1474-4422(21)00252-0.
Montaño A, Hanley DF, Hemphill JC 3rd. Hemorrhagic stroke. Handb Clin Neurol. 2021; 176:229-48. doi: 10.1016/B978-0-444-64034-5.00019-5.
Xian Y, Zhang S, Inohara T, Grau-Sepulveda M, Matsouaka RA, Peterson ED, et al. Clinical characteristics and outcomes associated with oral anticoagulant use among patients hospitalized with intracerebral hemorrhage. JAMA Netw Open. 2021 Feb 1;4(2):e2037438. doi: 10.1001/jamanetworkopen.2020.37438.
Carlsson M, Wilsgaard T, Johnsen SH, Johnsen LH, Løchen ML, Njølstad I, et al. Long-term survival, causes of death, and trends in 5-year mortality after intracerebral hemorrhage: the Tromsø Study. Stroke. 2021 Dec;52(12):3883-90. doi: 10.1161/STROKEAHA.120.032750.
Seiffge DJ, Goeldlin MB, Tatlisumak T, Lyrer P, Fischer U, Engelter ST, et al. Meta-analysis of haematoma volume, haematoma expansion and mortality in intracerebral haemorrhage associated with oral anticoagulant use. J Neurol. 2019 Dec;266(12):3126-35. doi: 10.1007/s00415-019-09536-1.
Tsivgoulis G, Wilson D, Katsanos AH, Sargento-Freitas J, Marques-Matos C, Azevedo E, et al. Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage. Ann Neurol. 2018 Nov;84(5):694-704. doi: 10.1002/ana.25342.
Boulouis G, Morotti A, Pasi M, Goldstein JN, Gurol ME, Charidimou A. Outcome of intracerebral haemorrhage related to non-vitamin K antagonists oral anticoagulants versus vitamin K antagonists: a comprehensive systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2018 Mar;89(3):263-70. doi: 10.1136/jnnp-2017-316631.
Rebchuk AD, O'Neill ZR, Szefer EK, Hill MD, Field TS. Health utility weighting of the modified Rankin Scale: a systematic review and meta-analysis. JAMA Netw Open. 2020 Apr 1;3(4):e203767. doi: 10.1001/jamanetworkopen.2020.3767.
Apostolaki-Hansson T, Ullberg T, Norrving B, Petersson J. Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment. Acta Neurol Scand. 2019 May;139(5):415-21. doi: 10.1111/ane.13068.
von der Brelie C, Doukas A, Naumann R, Dempfle A, Larsen N, Synowitz M, et al. Clinical and radiological course of intracerebral haemorrhage associated with the new non-vitamin K anticoagulants. Acta Neurochir (Wien). 2017 Jan;159(1):101-9. doi: 10.1007/s00701-016-3026-7.
Siepen BM, Forfang E, Branca M, Drop B, Mueller M, Goeldlin MB, et al. Intracerebral haemorrhage in patients taking different types of oral anticoagulants: a pooled individual patient data analysis from two national stroke registries. Stroke Vasc Neurol. 2024 Dec 30;9(6):640-51. doi: 10.1136/svn-2023-002813.
Wilson D, Seiffge DJ, Traenka C, Basir G, Purrucker JC, Rizos T, et al. Outcome of intracerebral hemorrhage associated with different oral anticoagulants. Neurology. 2017 May 2;88(18):1693-700. doi: 10.1212/WNL.0000000000003886.
Miller MM, Lowe J, Khan M, Azeem MU, Muehlschlegel S, Jun-O'Connell AH, et al. Clinical and radiological characteristics of vitamin K versus non-vitamin k antagonist oral anticoagulation-related intracerebral hemorrhage. Neurocrit Care. 2019 Aug;31(1):56-65. doi: 10.1007/s12028-019-00671-1.
Tsivgoulis G, Lioutas VA, Varelas P, Katsanos AH, Goyal N, Mikulik R, et al. Direct oral anticoagulant- vs vitamin K antagonist-related nontraumatic intracerebral hemorrhage. Neurology. 2017 Sep 12;89(11):1142-51. doi: 10.1212/WNL.0000000000004362.
Wilson D, Charidimou A, Shakeshaft C, Ambler G, White M, Cohen H, et al.; CROMIS-2 collaborators. Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type. Neurology. 2016 Jan 26;86(4):360-6. doi: 10.1212/WNL.0000000000002310.
Wang RH, Wen WX, Jiang ZP, Du ZP, Ma ZH, Lu AL, et al. The clinical value of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage. Front Immunol. 2023 Feb 13;14:1115031. doi: 10.3389/fimmu.2023.1115031.
Zhao G, Gu Y, Wang Z, Chen Y, Xia X. The clinical value of inflammation index in predicting ICU mortality of critically ill patients with intracerebral hemorrhage. Front Public Health. 2024 Aug 2;12:1373585. doi: 10.3389/fpubh.2024.1373585.
