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Prognosis for intracerebral hemorrhage during ongoing oral anticoagulant treatment.

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. This article is protected by copyright. All rights reserved.

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