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Oral Anticoagulation and Functional Outcome after Intracerebral Hemorrhage.
- Source :
-
Annals of neurology [Ann Neurol] 2017 Nov; Vol. 82 (5), pp. 755-765. Date of Electronic Publication: 2017 Oct 31. - Publication Year :
- 2017
-
Abstract
- Objective: Oral anticoagulation treatment (OAT) resumption is a therapeutic dilemma in intracerebral hemorrhage (ICH) care, particularly for lobar hemorrhages related to amyloid angiopathy. We sought to determine whether OAT resumption after ICH is associated with long-term outcome, accounting for ICH location (ie, lobar vs nonlobar).<br />Methods: We meta-analyzed individual patient data from: (1) the multicenter RETRACE study (n = 542), (2) a U.S.-based single-center ICH study (n = 261), and (3) the Ethnic/Racial Variations of Intracerebral Hemorrhage study (n = 209). We determined whether, within 1 year from ICH, OAT resumption was associated with: (1) mortality, (2) favorable functional outcome (modified Rankin Scale = 0-3), and (3) stroke incidence. We separately analyzed nonlobar and lobar ICH cases using propensity score matching and Cox regression models.<br />Results: We included 1,012 OAT-related ICH survivors (633 nonlobar and 379 lobar). Among nonlobar ICH survivors, 178/633 (28%) resumed OAT, whereas 86/379 (23%) lobar ICH survivors did. In multivariate analyses, OAT resumption after nonlobar ICH was associated with decreased mortality (hazard ratio [HR] = 0.25, 95% confidence interval [CI] = 0.14-0.44, p < 0.0001) and improved functional outcome (HR = 4.22, 95% CI = 2.57-6.94, p < 0.0001). OAT resumption after lobar ICH was also associated with decreased mortality (HR = 0.29, 95% CI = 0.17-0.45, p < 0.0001) and favorable functional outcome (HR = 4.08, 95% CI = 2.48-6.72, p < 0.0001). Furthermore, OAT resumption was associated with decreased all-cause stroke incidence in both lobar and nonlobar ICH (both p < 0.01).<br />Interpretation: These results suggest novel evidence of an association between OAT resumption and outcome following ICH, regardless of hematoma location. These findings support conducting randomized trials to explore risks and benefits of OAT resumption after ICH. Ann Neurol 2017;82:755-765.<br /> (© 2017 American Neurological Association.)
- Subjects :
- Administration, Oral
Aged
Anticoagulants administration & dosage
Cerebral Hemorrhage mortality
Clinical Trials as Topic statistics & numerical data
Female
Humans
Incidence
Longitudinal Studies
Male
Treatment Outcome
United States epidemiology
Anticoagulants therapeutic use
Cerebral Hemorrhage drug therapy
Stroke epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1531-8249
- Volume :
- 82
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Annals of neurology
- Publication Type :
- Academic Journal
- Accession number :
- 29028130
- Full Text :
- https://doi.org/10.1002/ana.25079