Abstract TP420: Clinical and Imaging Characteristics in Noac-Related Intracerebral Hemorrhage

Abstract

Importance: Given recent studies that provided controversial results it is intensely debated whether clinical and imaging characteristics, as well as functional outcome, differ among patients with intracerebral hemorrhage (ICH) related to vitamin K antagonists(VKA) versus non-vitamin K antagonist oral anticoagulant (NOAC) related ICH. Methods: This retrospective cohort study analyzed individual patient data of 1,328 patients with oral anticoagulation (OAC)-associated ICH over a 5-year-period (2011-2015) at 19 Departments of Neurology across Germany (ClinicalTrials.gov Identifier: NCT03093233). We compared baseline and hematoma characteristics as well as outcome in NOAC- versus VKA-related ICH, specifically correlating NOAC-dosing regimes. Functional outcome was assessed at 3 months using the modified Rankin scale (mRS) and multiple imputation was undertaken for missing outcome data. Results: Overall, 190 patients with NOAC- and 1138 with VKA-related ICH were available for analyses. Despite older age and more frequent arterial hypertension in NOAC-patients, there were no relevant differences in clinical and hematoma characteristics between NOAC- and VKA-related ICH, notably baseline hematoma volume (median(IQR): NOAC 14.7(5.1-42.3)ml vs. VKA 17.3(6.0-43.0)ml; p=0.21) rate of hematoma expansion (HE) (No.(%) NOAC 46/146(31.5%) vs. VKA 262/753(34.8%); p=0.44) and proportion of patients with favorable outcome were similar (mRS 0-3 at 3 months, No. (%): NOAC 55/190(28.9%) vs. VKA 337/1138(29.6%); p=0.86). Subanalyses of different NOAC-dosing regimes (regular dose: n=96 versus reduced dose: n=65) revealed similar NOAC-plasma levels and no differences regarding initial ICH-volume, rate of HE or functional outcome among patients with NOAC at low- and high-dosing regime. Conclusion: Among patients with anticoagulant-related ICH, there were no significant differences between those with NOAC-related ICH compared to those with VKA-related ICH in functional outcomes at 3 months or in frequency of HE. NOAC-dosage does not seem to influence hematoma characteristics in patients with OAC-related ICH.