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      Volume and Characteristics of Intracerebral Hemorrhage with Direct Oral Anticoagulants in Comparison with Warfarin

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          Abstract

          Background

          Patients undergoing anticoagulation therapy often experience intracerebral hemorrhages (ICHs), and warfarin in particular is known to increase hematoma expansion in ICHs, which results in a poor outcome. Recent studies reported that, in comparison with warfarin, direct oral anticoagulants (DOACs) cause fewer ICHs with better functional outcome. However, since it is still unknown whether DOACs are associated with a smaller hematoma volume of ICHs, we aimed to compare the volume, hematoma expansion, and outcomes associated with ICHs treated with DOACs and warfarin.

          Methods

          We performed a prospective multicenter cross-sectional study. The subjects included patients with acute ICHs who received either DOACs or warfarin. We evaluated the clinical characteristics, and measured initial and follow-up ICH volumes. The volume of ICHs and hematoma expansion were compared between the DOAC and warfarin groups. Mortality and modified Rankin score at discharge were evaluated as outcomes.

          Results

          There were 18 patients in the DOAC group and 71 in the warfarin group. The baseline characteristics were similar between the 2 groups. Initial median hematoma volume of ICHs in the DOAC group was significantly lower than that in the warfarin group (6.2 vs. 24.2 mL, respectively; p = 0.04). In cases involving follow-up computed tomography scanning, the median hematoma volume of ICHs at follow-up was lower in the DOAC group than in the warfarin group (initial: DOACs 4.4 vs. warfarin 13.5 mL; follow-up: 5.0 vs. 18.4 mL, respectively; p = 0.05). Further, the hematoma in ICHs associated with DOACs did not expand. Although the mortality of ICHs associated with DOACs (11%) was lower than that associated with warfarin (24%), this difference was not statistically significant. The univariate analysis showed that the anticoagulant type (DOACs vs. warfarin) and sex (male vs. female) were associated with ICH volume. The multivariable linear regression showed that the use of DOACs (compared to warfarin; β: −0.23, p = 0.03) and female sex (compared to male; β: −0.25, p = 0.02) were associated with a small hematoma volume.

          Conclusions

          Based on the results of the present study, in terms of the risks associated with ICHs, the use of DOACs appears to be safer than warfarin for anticoagulation therapy. Further studies are required to validate these findings.

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          Most cited references17

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          The ABCs of Measuring Intracerebral Hemorrhage Volumes

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            The ABCs of measuring intracerebral hemorrhage volumes.

            Hemorrhage volume is a powerful predictor of 30-day mortality after spontaneous intracerebral hemorrhage (ICH). We compared a bedside method of measuring CT ICH volume with measurements made by computer-assisted planimetric image analysis. The formula ABC/2 was used, where A is the greatest hemorrhage diameter by CT, B is the diameter 90 degrees to A, and C is the approximate number of CT slices with hemorrhage multiplied by the slice thickness. The ICH volumes for 118 patients were evaluated in a mean of 38 seconds and correlated with planimetric measurements (R2 = 9.6). Interrater and intrarater reliability were excellent, with an intraclass correlation of .99 for both. We conclude that ICH volume can be accurately estimated in less than 1 minute with the simple formula ABC/2.
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              Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation.

              Intracranial hemorrhage rates are higher in Asians than non-Asians, especially in patients receiving warfarin. This randomized evaluation of long-term anticoagulation therapy subgroup analysis assessed dabigatran etexilate (DE) and warfarin effects on stroke and bleeding rates in patients from Asian and non-Asian countries.
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                Author and article information

                Journal
                Cerebrovasc Dis Extra
                Cerebrovasc Dis Extra
                CEE
                Cerebrovascular Diseases Extra
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                1664-5456
                Jan-Apr 2017
                3 April 2017
                3 April 2017
                : 7
                : 1
                : 62-71
                Affiliations
                [1] aDepartment of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
                [2] bDepartment of Neurosurgery, Saiseikai Misumi Hospital, Uki-city, Japan
                Author notes
                *Tomohide Adachi, Department of Neurology, Tokyo Saiseikai Central Hospital, 1-4-17, Mita, Minato-ku, Tokyo 108-0073 (Japan), E-Mail adachi3@ 123456saichu.jp
                Article
                cee-0007-0062
                10.1159/000462985
                5425761
                28376486
                12d59cc7-bb5c-4861-86a7-4ca8d55fb1ab
                Copyright © 2017 by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.

                History
                : 11 October 2016
                : 8 February 2017
                Page count
                Figures: 2, Tables: 4, References: 22, Pages: 10
                Categories
                Original Paper

                Cardiovascular Medicine
                hemorrhage associated with oral anticoagulation,anticoagulants,intracerebral hemorrhage

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