Abstract WP438: Hematoma Expansion and Outcomes in Vitamin K versus Non-Vitamin K Antagonist Oral Anticoagulation Related Intracerebral Hemorrhages

Abstract

Background: There is mounting evidence that functional outcome after intracranial hemorrhage (ICH) related to non-vitamin K antagonist oral anticoagulation (NOAC-ICH) is similar if not better as compared to vitamin K antagonist (VKA)-related ICH (VKA-ICH). This has been partially attributed to a smaller initial hematoma volume (HV). However, the association with other hematoma characteristics such as hematoma expansion (HE) are not well understood. Methods: We retrospectively analyzed 102 consecutive patients with acute non-traumatic ICH on oral anticoagulation therapy to compare HV and HE, and their relation to the 90-day modified Rankin scale (mRS) score. Results: A specific reversal agent was used in 72 (93.5%) VKA-ICH versus two (8%) NOAC-ICH. In unadjusted analyses, VKA-ICH (n=77) and NOAC ICH (n=25) had a similar admission HV (p>0.05) and HE (p>0.05), and NOAC-ICH patients more frequently had lower 90-day mRS scores than VKA-ICH patients (p=0.017). After adjustment, an unfavorable 90-day functional outcome (mRS 4-6) was independently associated with lower admission Glasgow coma scale score (OR 1.63; 95%-CI 1.26-2.10; p<0.001) and greater HV (OR 1.03; 95%-CI 1.00-1.05; p=0.046), but not the oral anticoagulant strategy (OR 2.85; 95%-CI 0.69-11.86; p=0.15). After exclusion of patients without follow-up head CT to allow for adjustment by the HE, VKA-ICH was associated with an approximately 3.5 times greater odds for a poor 90-day outcome (OR 3.64; 95%-CI 1.01-13.09; p=0.048). Conclusions: Our observations support the notion that NOAC does not relate to a worse ICH extent and post-ICH functional outcome, information that may aid clinical decision making if confirmed in prospective studies.