Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment

Abstract

Background Intracerebral hemorrhage (ICH) is the most serious adverse effect of treatment with oral anticoagulants. Prognostic data after ICH associated with non‐vitamin K antagonist oral anticoagulants (NOAC) compared to vitamin K antagonists (VKA) are sparse. We compared 90‐day survival and functional outcome following NOAC‐ICH versus VKA‐ICH using data from the Swedish Stroke Register (Riksstroke). Methods Using data from Riksstroke and the Swedish Causes of Death Register between 2012 and 2016, we compared all‐cause 90‐day mortality for patients with NOAC‐ICH versus VKA‐ICH using Kaplan‐Meier survival analysis and Log‐rank test. Cox regression, with adjustment for age, sex, previous stroke, and level of consciousness (LOC) on admission, was used to estimate hazard ratios (HR) for 90‐day mortality. Estimated functional outcome at 90 days, based on the modified Rankin Scale (mRS), was compared between VKA‐ and NOAC‐associated ICH using chi‐squared test. Results We included 2483 patients; 300 with NOAC‐ICH and 2183 with VKA‐ICH. In both groups, mean age was 79 years, and 58% were male. No significant difference between NOAC‐ICH and VKA‐ICH was found for all‐cause 90‐day mortality (44.3% NOAC‐ICH versus 42.6% VKA‐ICH; P = 0.54, HR = 0.93; 95% confidence interval (CI): 0.78‐1.12) or 90‐day estimated functional outcome (mRS 0‐2:13.7% and 15.3%; mRS 3‐5:27.3% and 28.9%, respectively (P = 0.52)). Factors predicting death were increased age (HR = 1.03; 95%CI: 1.02‐1.04) and reduced LOC (drowsy: HR = 3.48; 95%CI: 2.86‐4.23; comatose: HR = 12.27; 95%CI: 10.13‐14.87). Conclusion In this large study on anticoagulant‐associated ICH, we found no significant difference in mortality and functional outcome at 90 days between NOAC‐ICH versus VKA‐ICH.

DNA Hypomethylation of DOCK1 Leading to High Expression Correlates with Neurologic Deterioration and Poor Function Outcomes after Spontaneous Intracerebral Hemorrhage

“…A variety of potential factors, such as groups above 45 years of age, male gender, Asians, and low- and middle-income countries, have been identified related to the occurrence of ICH [ 5 , 6 ]. Additionally, arterial hypertension, heavy smoking, excessive drinking, obesity, and diabetes [ 7 ] as well as oral anticoagulants [ 8 ] have been associated with an increased risk of ICH. Among them, degenerative changes of small artery perforating branches caused by hypertension are considered as the primary risk factor of ICH [ 9 ].…”

Knockdown of liver-derived factor XII by GalNAc-siRNA ALN-F12 prevents thrombosis in mice without impacting hemostatic function

“…Among the current available anticoagulant therapeutics, including vitamin K antagonists, heparin, and direct inhibitors of Factor Xa or thrombin, bleeding is the most common complication [3]. Major bleeding, such as intracerebral bleeding or catastrophic gastrointestinal bleeding, is associated with significant risk of death [4,5]. Therefore, developing an effective anticoagulant with no or minimum bleeding risk represents an urgent need.…”

Identification and analysis of DNA methylation inflammation related key genes in intracerebral hemorrhage

“…It mainly refers to the space occupying effect of blood clot, hematoma increasing intracranial pressure, compressing brain tissue, causing cerebral ischemia and even cerebral hernia [8] . Secondary injury is mainly caused by hematoma pressing the brain tissue, resulting in the body releasing a large amount of thrombin, in ammatory reaction, complement reaction, released components of blood clot, free radicals and other waterfall reactions [9] . Head computed tomography (CTH) can clearly diagnose the volume of hemorrhage and the location of nerve injury, but it fails to improve the clinical symptoms after ICH.…”