title: Characteristics of intracerebral hemorrhage during rivaroxaban treatment: comparison with those during warfarin.
abstract: OBJECTIVE
  Neuroradiological characteristics and functional outcomes of patients with intracerebral hemorrhage (ICH) during novel oral anticoagulant treatment were not well defined. We examined these in comparison with those during warfarin treatment.
  
  
  METHODS
  The consecutive 585 patients with ICH admitted from April 2011 through October 2013 were retrospectively studied. Of all, 5 patients (1%) had ICH during rivaroxaban treatment, 56 (10%) during warfarin, and the other 524 (89%) during no anticoagulants. We focused on ICH during rivaroxaban and warfarin treatments and compared the clinical characteristics, neuroradiological findings, and functional outcomes.
  
  
  RESULTS
  Patients in the rivaroxaban group were all at high risk for major bleeding with hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS-BLED) score of 3 and higher rate of past history of ICH. Moreover, multiple cerebral microbleeds (≥4) were detected more frequently in rivaroxaban group than in warfarin (80% versus 29%; P=0.04). Hematoma volume in rivaroxaban group was markedly smaller than that in warfarin (median: 4 versus 11 mL; P=0.03). No patient in the rivaroxaban group had expansion of hematoma and surgical treatment. Rivaroxaban group showed lower modified Rankin Scale at discharge relative to warfarin, and the difference between modified Rankin Scale before admission and at discharge was smaller in rivaroxaban than in warfarin (median: 1 versus 3; P=0.047). No patient in the rivaroxaban group died during hospitalization, whereas 10 (18%) warfarin patients died.
  
  
  CONCLUSIONS
  Rivaroxaban-associated ICH occurs in patients at high risk for major bleeding. However, they had a relatively small hematoma, no expansion of hematoma, and favorable functional and vital outcomes compared with warfarin-associated ICH.
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Hagii
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tomita
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Metoki
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Saito
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shiroto
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Hitomi
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Takaatsu
authors.initials: T
authors.lastname: Kamada
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Seino
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Baba
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Uchizawa
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Iwata
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Osanai
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yasujima
authors.affiliation: From the Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan (J.H., N.M., S. Saito, H.S., H.H., T.K., S. Seino, K.T., Y.B., S. Sasaki, T.U., M.I., S.M., M.Y.); and Departments of Cardiology (H.T., T.O., K.O.) and Hypertension and Stroke Medicine (T.O., K.O.), Hirosaki University Graduate School of Medicine, Hirosaki, Japan. okumura@cc.hirosaki-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D012189:Retrospective Studies; D012306:Risk; D000069552:Rivaroxaban; D020521:Stroke / Q000188:drug therapy; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D009025:Morpholines; D013876:Thiophenes; D014859:Warfarin; D000069552:Rivaroxaban
keywords: atrial fibrillation; intracranial hemorrhages; rivaroxaban