Abstract
ObjectiveTo obtain precise estimates of age, haematoma volume, secondary haematoma expansion (HE) and mortality for patients with intracerebral haemorrhage (ICH) taking oral anticoagulants [Vitamin K antagonists (VKA-ICH) or non-Vitamin K antagonist oral anticoagulants (NOAC-ICH)] and those not taking oral anticoagulants (non-OAC ICH) at ICH symptom onset.MethodsWe conducted a systematic review and meta-analysis of studies comparing VKA-ICH or NOAC-ICH or both with non-OAC ICH. Primary outcomes were haematoma volume (in ml), HE, and mortality (in-hospital and 3-month). We calculated odds ratios (ORs) using the Mantel–Haenszel random-effects method and corresponding 95% confidence intervals (95%CI) and determined the mean ICH volume difference.ResultsWe identified 19 studies including data from 16,546 patients with VKA-ICH and 128,561 patients with non-OAC ICH. Only 2 studies reported data on 4943 patients with NOAC-ICH. Patients with VKA-ICH were significantly older than patients with non-OAC ICH (mean age difference: 5.55 years, 95%CI 4.03–7.07, p < 0.0001, I2 = 92%, p < 0.001). Haematoma volume was significantly larger in VKA-ICH with a mean difference of 9.66 ml (95%CI 6.24–13.07 ml, p < 0.00001; I2 = 42%, p = 0.05). HE occurred significantly more often in VKA-ICH (OR 2.96, 95%CI 1.74–4.97, p < 0.00001; I2 = 65%). VKA-ICH was associated with significantly higher in-hospital mortality (VKA-ICH: 32.8% vs. non-OAC ICH: 22.4%; OR 1.83, 95%CI 1.61–2.07, p < 0.00001, I2 = 20%, p = 0.27) and 3-month mortality (VKA-ICH: 47.1% vs. non-OAC ICH: 25.5%; OR 2.24, 95%CI 1.52–3.31, p < 0.00001, I2 = 71%, p = 0.001). We did not find sufficient data for a meta-analysis comparing NOAC-ICH and non-OAC-ICH.ConclusionThis meta-analysis confirms, refines and expands findings from prior studies. We provide precise estimates of key prognostic factors and outcomes for VKA-ICH, which has larger haematoma volume, increased rate of HE and higher mortality compared to non-OAC ICH. There are insufficient data on NOACs.
Highlights
Intracerebral haemorrhage (ICH) is a devastating form of stroke with high mortality and morbidity [1]
Our main findings were that compared to non-Oral anticoagulants (OAC) ICH, Vitamin K antagonists (VKA)-ICH is associated with: (1) a higher mean haematoma volume of about 10 ml; (2) nearly twice the risk of in-hospital and 3-month mortality; and (3) nearly triple the risk of haematoma expansion (HE)
There are insufficient data to draw firm conclusions about non-vitamin K antagonist oral anticoagulants (NOAC)-ICH compared to non-OAC ICH
Summary
Intracerebral haemorrhage (ICH) is a devastating form of stroke with high mortality and morbidity [1]. Current knowledge about the influence of OAC on haematoma volume, secondary haematoma expansion (HE) and mortality in ICH is mainly based on data from small single centre studies conducted in the 1990s [4, 5] or early 2000s [6,7,8]. These studies found that ICH in patients on VKA therapy (VKA-ICH) was associated with larger haematoma volume and higher rates of HE and mortality compared to patients not taking OAC (non-OAC ICH). More recent studies were less consistent regarding the influence of VKA: some did not find differences in ICH volume [7, 9, 10], HE [9, 10] or mortality [9]; others found that VKA influences haematoma volume in non-lobar but not lobar ICH location [11], or if the INR was supratherapeutic (>3.0) [12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
