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1. Characteristics in Non–Vitamin K Antagonist Oral Anticoagulant–Related Intracerebral Hemorrhage

Author

Gerner, Stefan T., Kuramatsu, Joji B., Sembill, Jochen A., Sprügel, Maximilian I., Hagen, Manuel, Knappe, Ruben U., Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan C., Rizos, Timolaos, Volkmann, Jens, Müllges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, Erbguth, Frank, Nueckel, Martin, Schellinger, Peter D., Glahn, Jörg, Knappe, Ulrich J., Fink, Gereon R., Dohmen, Christian, Stetefeld, Henning, Fisse, Anna Lena, Minnerup, Jens, Hagemann, Georg, Rakers, Florian, Reichmann, Heinz, Schneider, Hauke, Rahmig, Jan, Ludolph, Albert Christian, Stösser, Sebastian, Neugebauer, Hermann, Röther, Joachim, Michels, Peter, Schwarz, Michael, Reimann, Gernot, Bäzner, Hansjörg, Schwert, Henning, Claßen, Joseph, Michalski, Dominik, Grau, Armin, Palm, Frederick, Urbanek, Christian, Wöhrle, Johannes C., Alshammari, Fahid, Horn, Markus, Bahner, Dirk, Witte, Otto W., Günther, Albrecht, Hamann, Gerhard F., Engelhorn, Tobias, Lücking, Hannes, Dörfler, Arnd, Schwab, Stefan, and Huttner, Hagen B.

Published
2019
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2. Association of Intraventricular Fibrinolysis With Clinical Outcomes in Intracerebral Hemorrhage: An Individual Participant Data Meta-Analysis

Author

Kuramatsu, Joji B., primary, Gerner, Stefan T., additional, Ziai, Wendy, additional, Bardutzky, Jürgen, additional, Sembill, Jochen A., additional, Sprügel, Maximilian I., additional, Mrochen, Anne, additional, Kölbl, Kathrin, additional, Ram, Malathi, additional, Avadhani, Radhika, additional, Falcone, Guido J., additional, Selim, Magdy H., additional, Lioutas, Vasileios-Arsenios, additional, Endres, Matthias, additional, Zweynert, Sarah, additional, Vajkoczy, Peter, additional, Ringleb, Peter A., additional, Purrucker, Jan C., additional, Volkmann, Jens, additional, Neugebauer, Hermann, additional, Erbguth, Frank, additional, Schellinger, Peter D., additional, Knappe, Ulrich J., additional, Fink, Gereon R., additional, Dohmen, Christian, additional, Minnerup, Jens, additional, Reichmann, Heinz, additional, Schneider, Hauke, additional, Röther, Joachim, additional, Reimann, Gernot, additional, Schwarz, Michael, additional, Bäzner, Hansjörg, additional, Claßen, Joseph, additional, Michalski, Dominik, additional, Witte, Otto W., additional, Günther, Albrecht, additional, Hamann, Gerhard F., additional, Lücking, Hannes, additional, Dörfler, Arnd, additional, Ishfaq, Muhammad Fawad, additional, Chang, Jason J., additional, Testai, Fernando D., additional, Woo, Daniel, additional, Alexandrov, Andrei V., additional, Staykov, Dimitre, additional, Goyal, Nitin, additional, Tsivgoulis, Georgios, additional, Sheth, Kevin N., additional, Awad, Issam A., additional, Schwab, Stefan, additional, Hanley, Daniel F., additional, Huttner, Hagen B., additional, Sansing, Lauren, additional, Matouk, Charles C., additional, Leasure, Audrey, additional, Sobesky, Jan, additional, Bauer, Miriam, additional, Schurig, Johannes, additional, Rizos, Timolaos, additional, Haeusler, Karl Georg, additional, Müllges, Wolfgang, additional, Kraft, Peter, additional, Schubert, Anna-Lena, additional, Stösser, Sebastian, additional, Ludolph, Albert Christian, additional, Nueckel, Martin, additional, Glahn, Jörg, additional, Stetefeld, Henning, additional, Rahmig, Jan, additional, Fisse, Anna Lena, additional, Michels, Peter, additional, Schwert, Henning, additional, Hagemann, Georg, additional, Rakers, Florian, additional, Wöhrle, Johannes C., additional, Alshammari, Fahid, additional, Horn, Markus, additional, Bahner, Dirk, additional, Urbanek, Christian, additional, Palm, Frederick, additional, and Grau, Armin, additional

Published
2022
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3. Association of prothrombin complex concentrate administration and hematoma enlargement in non–vitamin K antagonist oral anticoagulant–related intracerebral hemorrhage

Author

Gerner, Stefan T., Kuramatsu, Joji B., Sembill, Jochen A., Sprügel, Maximilian I., Endres, Matthias, Haeusler, Karl Georg, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan, Rizos, Timolaos, Erbguth, Frank, Schellinger, Peter D., Fink, Gereon R., Stetefeld, Henning, Schneider, Hauke, Neugebauer, Hermann, Röther, Joachim, Claßen, Joseph, Michalski, Dominik, Dörfler, Arnd, Schwab, Stefan, Huttner, Hagen B., Horn, Markus, Bahner, Dirk, Hagemann, Georg, Rakers, Florian, Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Fink, Gereon R., Dohmen, Christian, Stetefeld, Henning, Schwarz, Michael, Reimann, Gernot, Reichmann, Heinz, Schneider, Hauke, Rahmig, Jan, Gerner, Stefan T., Kuramatsu, Joji B., Bogenreuther, Christina, Sembill, Jochen A., Sprügel, Maximilian I., Hagen, Manuel, Knappe, Ruben, Köhrmann, Martin, Schwab, Stefan, Huttner, Hagen B., Kloska, Stephan P., Dörfler, Arnd, Ringwald, Jürgen, Hamann, Gerhard F., Röther, Joachim, Michels, Peter, Ringleb, Peter A., Purrucker, Jan, Rizos, Timolaos, Witte, Otto W., Günther, Albrecht, Wöhrle, Johannes C., Alshammari, Fahid, Claßen, Joseph, Michalski, Dominik, Grau, Armin, Palm, Frederick, Urbanek, Christian, Schellinger, Peter D., Glahn, Jörg, Knappe, Ulrich J., Wiendl, Heinz, Fisse, Anna Lena, Minnerup, Jens, Erbguth, Frank, Nueckel, Martin, Bäzner, Hansjörg, Schwert, Henning, Ludolph, Albert Christian, Stösser, Sebastian, Neugebauer, Hermann, Volkmann, Jens, Müllges, Wolfgang, Kraft, Peter, and Schubert, Anna‐Lena

Published
2018
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4. Association of intraventricular fibrinolysis with clinical outcomes in intracerebral hemorrhage: an individual participant data meta-analysis

Author

Kuramatsu, Joji B, Gerner, Stefan T, Falcone, Guido J, Selim, Magdy H, Lioutas, Vasileios-Arsenios, Endres, Matthias, Zweynert, Sarah, Vajkoczy, Peter, Ringleb, Peter A, Purrucker, Jan C, Volkmann, Jens, Neugebauer, Hermann, Ziai, Wendy, Erbguth, Frank, Schellinger, Peter D, Knappe, Ulrich J, Fink, Gereon R, Dohmen, Christian, Minnerup, Jens, Reichmann, Heinz, Schneider, Hauke, Röther, Joachim, Reimann, Gernot, Bardutzky, Jürgen, Schwarz, Michael, Bäzner, Hansjörg, Claßen, Joseph, Michalski, Dominik, Witte, Otto W, Günther, Albrecht, Hamann, Gerhard F, Lücking, Hannes, Dörfler, Arnd, Ishfaq, Muhammad Fawad, Sembill, Jochen A, Chang, Jason J, Testai, Fernando D, Woo, Daniel, Alexandrov, Andrei V, Staykov, Dimitre, Goyal, Nitin, Tsivgoulis, Georgios, Sheth, Kevin N, Awad, Issam A, Schwab, Stefan, Sprügel, Maximilian I, Hanley, Daniel F, Huttner, Hagen B, Collaborators, Sansing, Lauren, Matouk, Charles C, Leasure, Audrey, Sobesky, Jan, Bauer, Miriam, Schurig, Johannes, Rizos, Timolaos, Mrochen, Anne, Haeusler, Karl Georg, Müllges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, Stösser, Sebastian, Ludolph, Albert, Nueckel, Martin, Glahn, Jörg, Stetefeld, Henning, Rahmig, Jan, Kölbl, Kathrin, Fisse, Anna Lena, Michels, Peter, Schwert, Henning, Hagemann, Georg, Rakers, Florian, Wöhrle, Johannes C, Alshammari, Fahid, Horn, Markus, Bahner, Dirk, Urbanek, Christian, Ram, Malathi, Palm, Frederick, Grau, Armin, and Avadhani, Radhika

Subjects
Advanced and Specialized Nursing, drug therapy [Cerebral Hemorrhage], Fibrinolysis, diagnostic imaging [Cerebral Hemorrhage], intracerebral hemorrhage, mortality, Observational Studies as Topic, Treatment Outcome, Fibrinolytic Agents, standard of care, Drainage, Humans, Neurology (clinical), methods [Drainage], ddc:610, Cardiology and Cardiovascular Medicine, hydrocephalus, Cerebral Hemorrhage, Hydrocephalus
Abstract

Background: In patients with intracerebral hemorrhage (ICH), the presence of intraventricular hemorrhage constitutes a promising therapeutic target. Intraventricular fibrinolysis (IVF) reduces mortality, yet impact on functional disability remains unclear. Thus, we aimed to determine the influence of IVF on functional outcomes. Methods: This individual participant data meta-analysis pooled 1501 patients from 2 randomized trials and 7 observational studies enrolled during 2004 to 2015. We compared IVF versus standard of care (including placebo) in patients treated with external ventricular drainage due to acute hydrocephalus caused by ICH with intraventricular hemorrhage. The primary outcome was functional disability evaluated by the modified Rankin Scale (mRS; range: 0–6, lower scores indicating less disability) at 6 months, dichotomized into mRS score: 0 to 3 versus mRS: 4 to 6. Secondary outcomes included ordinal-shift analysis, all-cause mortality, and intracranial adverse events. Confounding and bias were adjusted by random effects and doubly robust models to calculate odds ratios and absolute treatment effects (ATE). Results: Comparing treatment of 596 with IVF to 905 with standard of care resulted in an ATE to achieve the primary outcome of 9.3% (95% CI, 4.4–14.1). IVF treatment showed a significant shift towards improved outcome across the entire range of mRS estimates, common odds ratio, 1.75 (95% CI, 1.39–2.17), reduced mortality, odds ratio, 0.47 (95% CI, 0.35–0.64), without increased adverse events, absolute difference, 1.0% (95% CI, −2.7 to 4.8). Exploratory analyses provided that early IVF treatment (≤48 hours) after symptom onset was associated with an ATE, 15.2% (95% CI, 8.6–21.8) to achieve the primary outcome. Conclusions: As compared to standard of care, the administration of IVF in patients with acute hydrocephalus caused by intracerebral and intraventricular hemorrhage was significantly associated with improved functional outcome at 6 months. The treatment effect was linked to an early time window

Published
2022

5. Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage

Author

Kuramatsu, Joji B., primary, Biffi, Alessandro, additional, Gerner, Stefan T., additional, Sembill, Jochen A., additional, Sprügel, Maximilian I., additional, Leasure, Audrey, additional, Sansing, Lauren, additional, Matouk, Charles, additional, Falcone, Guido J., additional, Endres, Matthias, additional, Haeusler, Karl Georg, additional, Sobesky, Jan, additional, Schurig, Johannes, additional, Zweynert, Sarah, additional, Bauer, Miriam, additional, Vajkoczy, Peter, additional, Ringleb, Peter A., additional, Purrucker, Jan, additional, Rizos, Timolaos, additional, Volkmann, Jens, additional, Müllges, Wolfgang, additional, Kraft, Peter, additional, Schubert, Anna-Lena, additional, Erbguth, Frank, additional, Nueckel, Martin, additional, Schellinger, Peter D., additional, Glahn, Jörg, additional, Knappe, Ulrich J., additional, Fink, Gereon R., additional, Dohmen, Christian, additional, Stetefeld, Henning, additional, Fisse, Anna Lena, additional, Minnerup, Jens, additional, Hagemann, Georg, additional, Rakers, Florian, additional, Reichmann, Heinz, additional, Schneider, Hauke, additional, Rahmig, Jan, additional, Ludolph, Albert Christian, additional, Stösser, Sebastian, additional, Neugebauer, Hermann, additional, Röther, Joachim, additional, Michels, Peter, additional, Schwarz, Michael, additional, Reimann, Gernot, additional, Bäzner, Hansjörg, additional, Schwert, Henning, additional, Claßen, Joseph, additional, Michalski, Dominik, additional, Grau, Armin, additional, Palm, Frederick, additional, Urbanek, Christian, additional, Wöhrle, Johannes C., additional, Alshammari, Fahid, additional, Horn, Markus, additional, Bahner, Dirk, additional, Witte, Otto W., additional, Günther, Albrecht, additional, Hamann, Gerhard F., additional, Hagen, Manuel, additional, Roeder, Sebastian S., additional, Lücking, Hannes, additional, Dörfler, Arnd, additional, Testai, Fernando D., additional, Woo, Daniel, additional, Schwab, Stefan, additional, Sheth, Kevin N., additional, and Huttner, Hagen B., additional

Published
2019
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6. Heparin for prophylaxis of venous thromboembolism in intracerebral haemorrhage

Author

Sprügel, Maximilian I, primary, Sembill, Jochen A, additional, Kuramatsu, Joji B, additional, Gerner, Stefan T, additional, Hagen, Manuel, additional, Roeder, Sebastian S, additional, Endres, Matthias, additional, Haeusler, Karl Georg, additional, Sobesky, Jan, additional, Schurig, Johannes, additional, Zweynert, Sarah, additional, Bauer, Miriam, additional, Vajkoczy, Peter, additional, Ringleb, Peter Arthur, additional, Purrucker, Jan Christoph, additional, Rizos, Timolaos, additional, Volkmann, Jens, additional, Muellges, Wolfgang, additional, Kraft, Peter, additional, Schubert, Anna-Lena, additional, Erbguth, Frank, additional, Nueckel, Martin, additional, Schellinger, Peter D, additional, Glahn, Jörg, additional, Knappe, Ulrich J, additional, Fink, Gereon Rudolf, additional, Dohmen, Christian, additional, Stetefeld, Henning, additional, Fisse, Anna Lena, additional, Minnerup, Jens, additional, Hagemann, Georg, additional, Rakers, Florian, additional, Reichmann, Heinz, additional, Schneider, Hauke, additional, Wöpking, Sigrid, additional, Ludolph, Albert C, additional, Stösser, Sebastian, additional, Neugebauer, Hermann, additional, Röther, Joachim, additional, Michels, Peter, additional, Schwarz, Michael, additional, Reimann, Gernot, additional, Bäzner, Hansjörg, additional, Schwert, Henning, additional, Classen, Joseph, additional, Michalski, Dominik, additional, Grau, Armin, additional, Palm, Frederick, additional, Urbanek, Christian, additional, Wöhrle, Johannes C, additional, Alshammari, Fahid, additional, Horn, Markus, additional, Bahner, Dirk, additional, Witte, Otto W, additional, Guenther, Albrecht, additional, Hamann, Gerhard F, additional, Lücking, Hannes, additional, Dörfler, Arnd, additional, Schwab, Stefan, additional, and Huttner, Hagen B, additional

Published
2019
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7. Association of prothrombin complex concentrate administration and hematoma enlargement in non-vitamin K antagonist oral anticoagulant-related intracerebral hemorrhage

Author

Gerner, Stefan T, Kuramatsu, Joji B, Erbguth, Frank, Schellinger, Peter D, Fink, Gereon R, Stetefeld, Henning, Schneider, Hauke, Neugebauer, Hermann, Röther, Joachim, Claßen, Joseph, Michalski, Dominik, Dörfler, Arnd, Sembill, Jochen A, Schwab, Stefan, Huttner, Hagen B, II, RETRACE, Horn, Markus, Bahner, Dirk, Hagemann, Georg, Rakers, Florian, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Sprügel, Maximilian I, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Dohmen, Christian, Schwarz, Michael, Reimann, Gernot, Reichmann, Heinz, Endres, Matthias, Bogenreuther, Christina, Hagen, Manuel, Knappe, Ruben, Köhrmann, Martin, Kloska, Stephan P, Ringwald, Jürgen, Hamann, Gerhard F, Michels, Peter, Ringleb, Peter A, Purrucker, Jan, Rizos, Timolaos, Witte, Otto W, Günther, Albrecht, Wöhrle, Johannes C, Alshammari, Fahid, Grau, Armin, Palm, Frederick, Urbanek, Christian, Glahn, Jörg, Knappe, Ulrich J, Wiendl, Heinz, Fisse, Anna Lena, Minnerup, Jens, Nueckel, Martin, Bäzner, Hansjörg, Schwert, Henning, Stösser, Sebastian, Volkmann, Jens, Müllges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, and Köhrmann, Martin (Beitragende*r)

Subjects
Male, therapeutic use [Hemostatics], Medizin, epidemiology [Germany], adverse effects [Blood Coagulation Factors], Blood Pressure, Hemostatics, therapeutic use [Blood Coagulation Factors], mortality [Hematoma], Cohort Studies, Germany, Humans, ddc:610, Hospital Mortality, adverse effects [Anticoagulants], Aged, Cerebral Hemorrhage, Retrospective Studies, Aged, 80 and over, prothrombin complex concentrates, Hematoma, pathology [Cerebral Hemorrhage], pathology [Hematoma], chemically induced [Cerebral Hemorrhage], chemically induced [Hematoma], Anticoagulants, Middle Aged, Blood Coagulation Factors, Treatment Outcome, Factor Xa, Female, mortality [Cerebral Hemorrhage]
Abstract

To investigate parameters associated with hematoma enlargement in non-vitamin K antagonist oral anticoagulant (NOAC)-related intracerebral hemorrhage (ICH).This retrospective cohort study includes individual patient data for 190 patients with NOAC-associated ICH over a 5-year period (2011-2015) at 19 departments of neurology across Germany. Primary outcome was the association of prothrombin complex concentrate (PCC) administration with hematoma enlargement. Subanalyses were calculated for blood pressure management and its association with the primary outcome. Secondary outcomes include associations with in-hospital mortality and functional outcome at 3 months assessed using the modified Rankin Scale.The study population for analysis of primary and secondary outcomes consisted of 146 NOAC-ICH patients with available follow-up imaging. Hematoma enlargement occurred in 49/146 (33.6%) patients with NOAC-related ICH. Parameters associated with hematoma enlargement were blood pressure ≥ 160mmHg within 4 hours and-in the case of factor Xa inhibitor ICH-anti-Xa levels on admission. PCC administration prior to follow-up imaging was not significantly associated with a reduced rate of hematoma enlargement either in overall NOAC-related ICH or in patients with factor Xa inhibitor intake (NOAC: risk ratio [RR] = 1.150, 95% confidence interval [CI] = 0.632-2.090; factor Xa inhibitor: RR = 1.057, 95% CI = 0.565-1.977), regardless of PCC dosage given or time interval until imaging or treatment. Systolic blood pressure levels 160mmHg within 4 hours after admission were significantly associated with a reduction in the proportion of patients with hematoma enlargement (RR = 0.598, 95% CI = 0.365-0.978). PCC administration had no effect on mortality and functional outcome either at discharge or at 3 months.In contrast to blood pressure control, PCC administration was not associated with a reduced rate of hematoma enlargement in NOAC-related ICH. Our findings support the need of further investigations exploring new hemostatic reversal strategies for patients with factor Xa inhibitor-related ICH. Ann Neurol 2018;83:186-196.

Published
2017

8. Management of therapeutic anticoagulation in patients with intracerebral haemorrhage and mechanical heart valves

Author

Kuramatsu, Joji B, primary, Sembill, Jochen A, additional, Gerner, Stefan T, additional, Sprügel, Maximilian I, additional, Hagen, Manuel, additional, Roeder, Sebastian S, additional, Endres, Matthias, additional, Haeusler, Karl Georg, additional, Sobesky, Jan, additional, Schurig, Johannes, additional, Zweynert, Sarah, additional, Bauer, Miriam, additional, Vajkoczy, Peter, additional, Ringleb, Peter A, additional, Purrucker, Jan, additional, Rizos, Timolaos, additional, Volkmann, Jens, additional, Müllges, Wolfgang, additional, Kraft, Peter, additional, Schubert, Anna-Lena, additional, Erbguth, Frank, additional, Nueckel, Martin, additional, Schellinger, Peter D, additional, Glahn, Jörg, additional, Knappe, Ulrich J, additional, Fink, Gereon R, additional, Dohmen, Christian, additional, Stetefeld, Henning, additional, Fisse, Anna Lena, additional, Minnerup, Jens, additional, Hagemann, Georg, additional, Rakers, Florian, additional, Reichmann, Heinz, additional, Schneider, Hauke, additional, Wöpking, Sigrid, additional, Ludolph, Albert Christian, additional, Stösser, Sebastian, additional, Neugebauer, Hermann, additional, Röther, Joachim, additional, Michels, Peter, additional, Schwarz, Michael, additional, Reimann, Gernot, additional, Bäzner, Hansjörg, additional, Schwert, Henning, additional, Claßen, Joseph, additional, Michalski, Dominik, additional, Grau, Armin, additional, Palm, Frederick, additional, Urbanek, Christian, additional, Wöhrle, Johannes C, additional, Alshammari, Fahid, additional, Horn, Markus, additional, Bahner, Dirk, additional, Witte, Otto W, additional, Günther, Albrecht, additional, Hamann, Gerhard F, additional, Lücking, Hannes, additional, Dörfler, Arnd, additional, Achenbach, Stephan, additional, Schwab, Stefan, additional, and Huttner, Hagen B, additional

Published
2018
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9. Heparin for prophylaxis of venous thromboembolism in intracerebral haemorrhage

Author

Spru¨gel, Maximilian I, Sembill, Jochen A, Kuramatsu, Joji B, Gerner, Stefan T, Hagen, Manuel, Roeder, Sebastian S, Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Ringleb, Peter Arthur, Purrucker, Jan Christoph, Rizos, Timolaos, Volkmann, Jens, Muellges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, Erbguth, Frank, Nueckel, Martin, Schellinger, Peter D, Glahn, Jo¨rg, Knappe, Ulrich J, Fink, Gereon Rudolf, Dohmen, Christian, Stetefeld, Henning, Fisse, Anna Lena, Minnerup, Jens, Hagemann, Georg, Rakers, Florian, Reichmann, Heinz, Schneider, Hauke, Wo¨pking, Sigrid, Ludolph, Albert C, Sto¨sser, Sebastian, Neugebauer, Hermann, Ro¨ther, Joachim, Michels, Peter, Schwarz, Michael, Reimann, Gernot, Ba¨zner, Hansjo¨rg, Schwert, Henning, Classen, Joseph, Michalski, Dominik, Grau, Armin, Palm, Frederick, Urbanek, Christian, Wo¨hrle, Johannes C, Alshammari, Fahid, Horn, Markus, Bahner, Dirk, Witte, Otto W, Guenther, Albrecht, Hamann, Gerhard F, Lu¨cking, Hannes, Do¨rfler, Arnd, Schwab, Stefan, and Huttner, Hagen B

Abstract

ObjectiveTo determine the occurrence of intracranial haemorrhagic complications (IHC) on heparin prophylaxis (low-dose subcutaneous heparin, LDSH) in primary spontaneous intracerebral haemorrhage (ICH) (not oral anticoagulation-associated ICH, non-OAC-ICH), vitamin K antagonist (VKA)-associated ICH and non-vitamin K antagonist oral anticoagulant (NOAC)-associated ICH.MethodsRetrospective cohort study (RETRACE) of 22 participating centres and prospective single-centre study with 1702 patients with VKA-associated or NOAC-associated ICH and 1022 patients with non-OAC-ICH with heparin prophylaxis between 2006 and 2015. Outcomes were defined as rates of IHC during hospital stay among patients with non-OAC-ICH, VKA-ICH and NOAC-ICH, mortality and functional outcome at 3 months between patients with ICH with and without IHC.ResultsIHC occurred in 1.7% (42/2416) of patients with ICH. There were no differences in crude incidence rates among patients with VKA-ICH, NOAC-ICH and non-OAC-ICH (log-rank p=0.645; VKA-ICH: 27/1406 (1.9%), NOAC-ICH 1/130 (0.8%), non-OAC-ICH 14/880 (1.6%); p=0.577). Detailed analysis according to treatment exposure (days with and without LDSH) revealed no differences in incidence rates of IHC per 1000 patient-days (LDSH: 1.43 (1.04–1.93) vs non-LDSH: 1.32 (0.33–3.58), conditional maximum likelihood incidence rate ratio: 1.09 (0.38–4.43); p=0.953). Secondary outcomes showed differences in functional outcome (modified Rankin Scale=4–6: IHC: 29/37 (78.4%) vs non-IHC: 1213/2048 (59.2%); p=0.019) and mortality (IHC: 14/37 (37.8%) vs non-IHC: 485/2048 (23.7%); p=0.045) in disfavour of patients with IHC. Small ICH volume (OR: volume <4.4 mL: 0.18 (0.04–0.78); p=0.022) and low National Institutes of Health Stroke Scale (NIHSS) score on admission (OR: NIHSS <4: 0.29 (0.11–0.78); p=0.014) were significantly associated with fewer IHC.ConclusionsHeparin administration for venous thromboembolism (VTE) prophylaxis in patients with ICH appears to be safe regarding IHC among non-OAC-ICH, VKA-ICH and NOAC-ICH in this observational cohort analysis. Randomised controlled trials are needed to verify the safety and efficacy of heparin compared with other methods for VTE prevention.

Published
2019
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