title: Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type.
abstract: OBJECTIVE
  To compare intracerebral hemorrhage (ICH) volume and clinical outcome of non-vitamin K oral anticoagulants (NOAC)-associated ICH to warfarin-associated ICH.
  
  
  METHODS
  In this multicenter cross-sectional observational study of patients with anticoagulant-associated ICH, consecutive patients with NOAC-ICH were compared to those with warfarin-ICH selected from a population of 344 patients with anticoagulant-associated ICH. ICH volume was measured by an observer blinded to clinical details. Outcome measures were ICH volume and clinical outcome adjusted for confounding factors.
  
  
  RESULTS
  We compared 11 patients with NOAC-ICH to 52 patients with warfarin-ICH. The median ICH volume was 2.4 mL (interquartile range [IQR] 0.3-5.4 mL) for NOAC-ICH vs 8.9 mL (IQR 4.0-21.3 mL) for warfarin-ICH (p = 0.0028). In univariate linear regression, use of warfarin (difference in cube root volume 1.61; 95% confidence interval [CI] 0.69 to 2.53) and lobar ICH location (compared with nonlobar ICH; difference in cube root volume 1.52; 95% CI 2.20 to 0.85) were associated with larger ICH volumes. In multivariable linear regression adjusting for confounding factors (sex, hypertension, previous ischemic stroke, white matter disease burden, and premorbid modified Rankin Scale score [mRS]), warfarin use remained independently associated with larger ICH (cube root) volumes (coefficient 0.64; 95% CI 0.24 to 1.25; p = 0.042). Ordered logistic regression showed an increased odds of a worse clinical outcome (as measured by discharge mRS) in warfarin-ICH compared with NOAC-ICH: odds ratio 4.46 (95% CI 1.10 to 18.14; p = 0.037).
  
  
  CONCLUSIONS
  In this small prospective observational study, patients with NOAC-associated ICH had smaller ICH volumes and better clinical outcomes compared with warfarin-associated ICH.
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: Wilson
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Charidimou
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Shakeshaft
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Ambler
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: White
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Cohen
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Tarek
authors.initials: T
authors.lastname: Yousry
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Rustam
authors.initials: R
authors.lastname: Al-Shahi Salman
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Brown
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK.
authors.forename: Hans Rolf
authors.initials: HR
authors.lastname: Jäger
authors.affiliation: From the Stroke Research Group (D.W., A.C., M.M.B., D.J.W.) and the Department of Brain Repair and Rehabilitation (D.W., A.C., C.S., M.W., T.Y., H.R.J., D.J.W.), UCL Institute of Neurology; Department of Statistical Science (G.A.), UCL; Lysholm Department of Neuroradiology (M.W., T.Y., H.R.J.), National Hospital for Neurology and Neurosurgery (D.W., A.C., M.M.B., D.J.W.), London; University College London Hospitals NHS Foundation Trust (H.C.); Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh; and University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK. d.werring@ucl.ac.uk.
authors.forename: David J
authors.initials: DJ
authors.lastname: Werring
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin