Haemorrhagic Transformation after Ischaemic Stroke in Patients Taking Non-vitamin K Antagonist Oral Anticoagulants.
OBJECTIVE
To evaluate the frequency and outcome of haemorrhagic transformation (HT) after ischaemic stroke in patients treated with non-vitamin K antagonist oral anticoagulants (NOACs).


METHODS
Patients with stroke on treatment with a NOAC were prospectively enrolled in this multicentre observational study between February 2012 and 2015. Brain imaging at admission and follow-up imaging until day 7 were reviewed for HT. Functional outcome was assessed by the modified Rankin scale (mRS) before the index event, at discharge, and at 3-months.


RESULTS
231 patients without recanalisation therapy (no-RT), and 32 patients with RT were eligible for analysis. Any HT was present at admission in 9/231 no-RT patients (3.9%, 95% CI 2.0 to 7.3) and in none of the patients with RT. In patients with follow-up imaging (no-RT, n=129, and RT, n=32), HT was present in 14.0% (no-RT; 95% CI, 8.9 to 21.1), and 40.6% (RT, 95% CI, 25.5 to 57.8), respectively. After adjustment for stroke severity, this difference between the no-RT and RT groups became non-significant. Symptomatic ICH was observed in 1 patient per group. HT was not associated with unfavourable outcome (mRS 3-6) at 3-months in multivariable analysis. Resumption of OAC after stroke was delayed in patients with HT compared to those without (15 d [IQR, 5-26] vs. 1 d [0-4],P<0.001).


CONCLUSIONS
The frequency and severity of HT after stroke on NOAC appears similar to previous reports for vitamin K antagonists and no anticoagulation. Whether asymptomatic HT should delay resumption of preventive anticoagulation requires further investigation.
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Jan C
JC
Purrucker
Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany.
Kirsten
K
Haas
Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Marcel
M
Wolf
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Timolaos
T
Rizos
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Shujah
S
Khan
Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
Peter
P
Kraft
Department of Neurology, Tübingen University, Tübingen, Germany.
Sven
S
Poli
Department of Neurology, University Hospital Münster, Germany.
Rainer
R
Dziewas
Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
Johannes
J
Meyne
Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
Frederick
F
Palm
Department of Neurology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany.
Sebastian
S
Jander
Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Markus
M
Möhlenbruch
Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany.|Comprehensive Heart Failure Center, and Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany.
Peter U
PU
Heuschmann
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.|Department of Stroke Medicine, Imperial College London, London, United Germany.
Roland
R
Veltkamp
Anticoagulation; Haemorrhagic Transformation; Stroke