Intracerebral Hematoma Occurring During Warfarin Versus Non-Vitamin K Antagonist Oral Anticoagulant Therapy.
The neuroradiological findings and its outcomes of intracerebral hemorrhage (ICH) were compared between the non-vitamin K antagonist oral anticoagulant (NOAC) therapy and warfarin therapy. In the latest 3 years, 13 cases of nonvalvular atrial fibrillation on NOAC therapy were admitted for ICH. For comparison, 65 age- and gender-comparable patients with ICH on warfarin therapy were recruited. Three NOACs had been prescribed: dabigatran (n = 4), rivaroxaban (n = 2), and apixaban (n = 7). The average ages were 76 ± 9 and 78 ± 8 years in the warfarin (n = 65) and NOAC groups (n = 13), respectively. There was no difference in the clinical features, including the CHADS2 score or HAS-BLED score: 2.62 ± 1.31 versus 2.62 ± 1.33, or 1.09 ± 0.43 versus 1.00 ± 0.41, for the warfarin and NOAC groups, respectively. The volume of ICH <30 ml was found in 84.6% of the patients on NOACs, but it was found in 53.8% of the patients on warfarin (p = 0.0106). The expansion of hematoma was limited to 7 patients (10.8%) of the warfarin group. A lower hospital mortality and better modified Rankin Scale were observed in the NOAC group than in the warfarin group: 1 (7.7%) versus 27 (41.5%; p = 0.0105) and 3.2 ± 1.4 versus 4.5 ± 1.6 (p = 0.0057), respectively. In conclusion, ICH on NOAC therapy had smaller volume of hematoma with reduced rate of expansion and decreased mortality compared with its occurrence on warfarin.
Department of Neurosurgery, Tachikawa General Hospital, Nagaoka, Japan; Department of Neurosurgery, Brain Research Institute of Niigata University, Nagaoka, Japan.
Haruhiko
H
Takahashi
Department of Neurosurgery, Tachikawa General Hospital, Nagaoka, Japan.
Yasushi
Y
Jimbo
Department of Neurology, Tachikawa General Hospital, Nagaoka, Japan.
Hiroki
H
Takano
Department of Neurosurgery, Tachikawa General Hospital, Nagaoka, Japan.
Hiroshi
H
Abe
Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan.
Masahito
M
Sato
Department of Neurosurgery, Brain Research Institute of Niigata University, Nagaoka, Japan.
Yukihiko
Y
Fujii
Department of Research and Development, Tachikawa Medical Center, Nagaoka, Japan. Electronic address: aizaways@med.niigata-u.ac.jp.
Yoshifusa
Y
Aizawa
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D000991:Antithrombins / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001921:Brain / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D000069604:Dabigatran / Q000009:adverse effects; D065427:Factor Xa Inhibitors / Q000009:adverse effects; D005260:Female; D006406:Hematoma / Q000139:chemically induced* / Q000000981:diagnostic imaging; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011720:Pyrazoles / Q000009:adverse effects; D011728:Pyridones / Q000009:adverse effects; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000009:adverse effects
D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran