title: Clinical and radiological course of intracerebral haemorrhage associated with the new non-vitamin K anticoagulants.
abstract: Clinical outcome and mortality in intracerebral haemorrhage (ICH) associated with anticoagulant treatment is poor. Novel direct oral anticoagulant drugs (NOACs) are increasingly prescribed. Management of NOAC-associated ICH might be more challenging. The aim of this study was to compare the clinical and radiological course of ICH patients being treated with different forms of oral anticoagulant drugs.
  
  
  
  The study is a retrospective observational study. Haemorrhage in other intracranial compartments except the ventricular system were explicitly excluded. Four groups were categorised and compared with regard to their clinical and radiological course (NOACs, vitamin K antagonists [VKAs], platelet inhibitors and patients without anticoagulant/antiplatelet drugs). Clinical as well as radiological parameters were analysed.
  
  
  
  Overall, 182 patients were included (2011 to early 2016). Twenty-five patients with NOAC-associated ICH were included (47 with VKAs, 50 with platelet inhibitors and 60 patients without anticoagulant/antiplatelet drugs). The frequency of NOAC-associated ICH increased over the years. Diabetes was found significantly more often in the NOAC patients (p = 0.05). The clinical and radiological courses in the three different patient groups with impaired coagulation were similar. Mortality was significantly higher in patient groups with impaired coagulation (p = 0.04) compared to those without anticoagulant/antiplatelet drugs. Multivariate analysis revealed the Glasgow Coma Scale (GCS) score as a strong predictor for worse outcome and mortality.
  
  
  
  The frequency of NOAC-associated ICH increased in the last 5 years. Diabetes might be a risk factor for ICH when receiving NOACs. Clinical outcome in NOAC-associated ICH is poor and mortality is as high as in patients with other oral anticoagulant/antiplatelet drugs.
authors.affiliation: Department of Neurosurgery, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany. cvdb@gmx.net.|Department of Neurosurgery, University Hospital of Göttingen, Robert Koch Strasse 40, 37075, Göttingen, Germany. cvdb@gmx.net.
authors.forename: Christian
authors.initials: C
authors.lastname: von der Brelie
authors.affiliation: Department of Neurosurgery, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Doukas
authors.affiliation: Department of Neurosurgery, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Naumann
authors.affiliation: Institute of Medical Informatics and Statistics, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Dempfle
authors.affiliation: Department of Radiology, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany.
authors.forename: Naomi
authors.initials: N
authors.lastname: Larsen
authors.affiliation: Department of Neurosurgery, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Synowitz
authors.affiliation: Department of Radiology, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany.
authors.forename: Olav
authors.initials: O
authors.lastname: Jansen
authors.affiliation: Department of Neurosurgery, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Mehdorn
authors.affiliation: Department of Neurosurgery, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany.
authors.forename: Senol
authors.initials: S
authors.lastname: Jadik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D012189:Retrospective Studies; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K
keywords: Clinical management; Intracerebal haemorrhage; Novel anticoagulant drug; Outcome; Surgical treatment