Warfarin associated intracerebral hemorrhage in Hong Kong Chinese

Teo, Kay‐Cheong; Mahboobani, NR; Lee, R.; Siu, Chung‐Wah; Cheung, Rtf; Ho, SL; Lau, Kui Kai; Chan, Koon‐Ho

doi:10.1179/1743132813y.0000000275

Cited by 19 publications

(10 citation statements)

References 47 publications

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“…Proportionally the ratio between ischaemic stroke to haemorrhagic stroke is lower in Asians compared to nonAsians [21]. Also, Asian patients have a higher mortality due to warfarin-induced intra-cranial haemorrhage (ICH) (62%) compared to Caucasians [22]. Nonetheless, the higher risks associated with Asians may not be a problem solely with warfarin.…”

Section: Epidemiology -A Brief Overviewmentioning

confidence: 97%

Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: Time for a reappraisal

Lip

Wang

Chiang

2015

International Journal of Cardiology

146

118

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Non-vitamin K antagonist oral anticoagulants (NOACs) have changed the landscape for stroke prevention in atrial fibrillation (AF). Given the huge burden of AF in Asians, more attention to stroke prevention is clearly needed. Aiming to provide an overview and reappraisal of stroke prevention in Asians with AF, we searched MEDLINE for information on NOACs in Asians. In addition, abstracts from national and international cardiovascular meetings were studied to identify unpublished studies. In the 4 recent Phase 3 trials comparing NOACs to warfarin, a consistent pattern is evident. For efficacy endpoints in the comparison of NOACs vs warfarin, a significant reduction in stroke/systemic embolization was seen for dabigatran 150mg [HR 0.45 (0.28-0.72)], with non-significant trends seen for lower stroke/systemic embolization with other NOACs, except edoxaban 30mg. A similar pattern was seen for ischaemic stroke, with a significant reduction for dabigatran 150mg [HR 0.55 (0.32-0.950]. For haemorrhagic stroke, all NOAC regimes, except rivaroxaban 20mg, had significantly lower hazard ratios. No evidence of increased myocardial infarction was found for NOACs. All-cause mortality was significantly lowered amongst Asian patients on edoxaban 60mg compared to warfarin [HR 0.63 (0.40-0.98)] with non-significant trends to lower mortality with dabigatran 150mg, rivaroxaban and edoxaban 30mg. For safety endpoints, all the NOAC regimes, except rivaroxaban 20mg, significantly reduced major bleeding and 'all bleeding' events. Intracranial haemorrhage was consistently lowered by all NOACs. None of NOACs increased gastrointestinal bleeding. These information suggested that NOACs should be preferentially indicated for stroke prevention in Asians with AF.

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Section: Epidemiology -A Brief Overviewmentioning

confidence: 97%

Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: Time for a reappraisal

Lip

Wang

Chiang

2015

International Journal of Cardiology

146

118

View full text Add to dashboard Cite

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“…Of the remaining 17 articles, 9 were excluded because they were only about anticoagulants [24][25][26][27][28][29][30][31][32], one was excluded because the majority of participants who had resumed antithrombotic agents had their medicine terminated or changed during the follow-up [33], and one was excluded because there was no clear record of which kind of antithrombotic agents, oral anticoagulant, or AP therapy was resumed [34]. Finally, only 6 articles met the inclusion criteria [35][36][37][38][39][40]. The study selection is presented in flow chart form in Fig.…”

Section: Study Selectionmentioning

confidence: 99%

“…The 6 studies offered data containing 1916 patients (825 in AP resumption group, 1091 in non-AP resumption group) [35][36][37][38][39][40]. Pooled result using the random-effects model showed that there was no significant difference between AP resumption group and non-AP resumption group for ICH recurrence or hematoma expansion (RR, 0.84; 95% CI, 0.47-1.51; P = 0.56) (Fig.…”

Section: Ap Resumption Did Not Significantly Increase Ich Recurrence mentioning

confidence: 99%

Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies

Ding

Liu

Tan

et al. 2018

Journal of the Neurological Sciences

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“…Included studies were published from 2005 to 2016, and sample sizes ranged from 20 23 to 1752 participants, 25 with the length of follow-up ranging from 12 17 20 24–27 to 55 months 21 ( table 1 , online supplementary table S2 ). The type of oral anticoagulants received at the time of ICH occurrence was VKA in all studies, with the exception of De Vleeschouwer et al 17 (the type of anticoagulation was not reported) and Nielsen et al 25 (some participants received NOAC).…”

Section: Resultsmentioning

confidence: 99%

Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis

Zhou

Carcel

et al. 2018

BMJ Open

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ObjectiveTo determine the adverse outcomes following resumption of anticoagulation in patients with anticoagulation-associated intracranial haemorrhage (ICH).DesignWe performed a systematic review and meta-analysis in this clinical population. The Preferred Reporting Items for Systemic Reviews and Meta-Analyses statement was followed, and two authors independently assessed eligibility of all retrieved studies and extracted data.Data sourcesMedline, Embase and the Cochrane Central Register of Controlled Trials, from inception to February 2017.Eligibility criteria and outcomesRandomised controlled trials or cohort studies that recruited adults who received oral anticoagulants at the time of ICH occurrence and survived after the acute phase or hospitalisation were searched. Primary outcomes, including long-term mortality, recurrent ICH and thromboembolic events. Secondary outcomes were the frequency of resuming anticoagulant therapy and related factors.ResultsWe included 12 cohort studies (no clinical trials) involving 3431 ICH participants. The pooled frequency of resuming anticoagulant therapy was 38% (95% CI 32% to 44%), but this was higher in participants with prosthetic heart valves, subarachnoid haemorrhage or dyslipidaemia. There was no evidence that resuming anticoagulant therapy was associated with higher long-term mortality (pooled relative risk (RR) 0.60, 95% CI 0.30 to 1.19; p=0.14) or ICH recurrence (pooled RR 1.14, 95% CI 0.72 to 1.80; p=0.57). Resumption of anticoagulation was associated with significantly fewer thromboembolic events (pooled RR 0.31, 95% CI 0.23 to 0.42; p<0.001). In a subgroup of patients with atrial fibrillation, resuming anticoagulant therapy was associated with fewer long-term mortality (pooled RR 0.27, 95% CI 0.20 to 0.37, p<0.001).ConclusionsBased on these observational studies, resuming anticoagulant therapy after anticoagulation-associated ICH has beneficial effects on long-term complications. Clinical trials are needed to substantiate these findings.PROSPERO registration numberCRD42017063827.

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Warfarin associated intracerebral hemorrhage in Hong Kong Chinese

Abstract: Warfarin-associated intracerebral hemorrhage is a very serious complication of warfarin therapy with high mortality and morbidity. Initial ICH volume, presence of intraventricular hemorrhage, and ND are independent predictors of clinical outcome.

Cited by 19 publications

References 47 publications

Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: Time for a reappraisal

Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: Time for a reappraisal

Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies

Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis

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