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Clinical and radiological course of intracerebral haemorrhage associated with the new non-vitamin K anticoagulants

  • Clinical Article - Vascular
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Abstract

Background

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.

Method

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany

    Christian von der Brelie, Alexandros Doukas, Rebecca Naumann, Michael Synowitz, Maximilian Mehdorn & Senol Jadik

  2. Department of Radiology, University Hospital of Schleswig Holstein, Campus Kiel, Arnold Heller Straße 3, 24103, Kiel, Germany

    Naomi Larsen & Olav Jansen

  3. Institute of Medical Informatics and Statistics, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany

    Astrid Dempfle

  4. Department of Neurosurgery, University Hospital of Göttingen, Robert Koch Strasse 40, 37075, Göttingen, Germany

    Christian von der Brelie

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  1. Christian von der Brelie
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  2. Alexandros Doukas
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  3. Rebecca Naumann
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  4. Astrid Dempfle
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  5. Naomi Larsen
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  6. Michael Synowitz
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  7. Olav Jansen
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  8. Maximilian Mehdorn
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  9. Senol Jadik
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Correspondence to Christian von der Brelie.

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No funding was received for this research.

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All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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von der Brelie, C., Doukas, A., Naumann, R. et al. Clinical and radiological course of intracerebral haemorrhage associated with the new non-vitamin K anticoagulants. Acta Neurochir 159, 101–109 (2017). https://doi.org/10.1007/s00701-016-3026-7

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  • DOI: https://doi.org/10.1007/s00701-016-3026-7

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