Objectives: This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)-associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database.
Methods: We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC- and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge.
Results: DOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, = 0.005), within 7 days (OR 2.29, = 0.037), and during hospitalization (OR 1.96, = 0.039).
Conclusions: This nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880631 | PMC |
| http://dx.doi.org/10.1212/WNL.0000000000005207 | DOI Listing |
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Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin.
Neurology
March 2018
From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan.
Objectives: This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)-associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database.
Methods: We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC- and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge.
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