Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants.

Jawed Nawabi,Melanie Liu,Bernd Hamm,Anna Speth,Tobias Penzkofer,Peter B Sporns,Jens Fiehler,Frieder Schlunk,Elif Can,Andrea Morotti,Sarah Elsayed,Tobias Faizy,Uta Hanning,Rosalie Mcdonough,Georg Bohner,Helge Kniep,Gabriel Broocks

doi:10.3390/jcm10112234

Abstract

Background: There is a need to examine the effects of different types of oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) on perihematomal edema (PHE), which is gaining considerable appeal as a biomarker for secondary brain injury and clinical outcome. Methods: In a large multicenter approach, computed tomography-derived imaging markers for PHE (absolute PHE, relative PHE (rPHE), edema expansion distance (EED)) were calculated for patients with OAC-ICH and NON-OAC-ICH. Exploratory analysis for non-vitamin-K-antagonist OAC (NOAC) and vitamin-K-antagonists (VKA) was performed. The predictive performance of logistic regression models, employing predictors of poor functional outcome (modified Rankin scale 4–6), was explored. Results: Of 811 retrospectively enrolled patients, 212 (26.14%) had an OAC-ICH. Mean rPHE and mean EED were significantly lower in patients with OAC-ICH compared to NON-OAC-ICH, p-value 0.001 and 0.007; whereas, mean absolute PHE did not differ, p-value 0.091. Mean EED was also significantly lower in NOAC compared to NON-OAC-ICH, p-value 0.05. Absolute PHE was an independent predictor of poor clinical outcome in NON-OAC-ICH (OR 1.02; 95%CI 1.002–1.028; p-value 0.027), but not in OAC-ICH (p-value 0.45). Conclusion: Quantitative markers of early PHE (rPHE and EED) were lower in patients with OAC-ICH compared to those with NON-OAC-ICH, with significantly lower levels of EED in NOAC compared to NON-OAC-ICH. Increase of early PHE volume did not increase the likelihood of poor outcome in OAC-ICH, but was independently associated with poor outcome in NON-OAC-ICH. The results underline the importance of etiology-specific treatment strategies. Further prospective studies are needed.

Highlights

In light of the aging population with increased cardiovascular comorbidity, the use of oral anticoagulation (OAC) is steadily expanding [1,2]
To test and evaluate this hypothesis, we present a two-phase analysis: First, computed tomography (CT)-derived imaging markers for early perihematomal edema (PHE) were calculated in patients with oral anticoagulantassociated intracerebral hemorrhage (OAC-ICH) and NON-OAC-ICH (absolute PHE, relative PHE, edema expansion distance (EED))
Patients with OAC-ICH had a higher percentage of arterial hypertension, with 83.49% in 177 patients and diabetes mellitus with 18.87% in 40 patients compared to patients with NON-OAC-ICH, p-value 0.008 and 0.048, respectively

Summary

Introduction

In light of the aging population with increased cardiovascular comorbidity, the use of oral anticoagulation (OAC) is steadily expanding [1,2]. PHE is gaining increasing attention as a promising surrogate marker for secondary brain injury, and clinical outcome [10,11,12,13] In light of these reports, a better understanding of PHE formation in OAC-ICH patients could help to improve clinical treatment, when utilizing established PHE quantification methods. To test and evaluate this hypothesis, we present a two-phase analysis: First, computed tomography (CT)-derived imaging markers for early PHE were calculated in patients with OAC-ICH and NON-OAC-ICH (absolute PHE, relative PHE (rPHE), edema expansion distance (EED)). There is a need to examine the effects of different types of oral anticoagulantassociated intracerebral hemorrhage (OAC-ICH) on perihematomal edema (PHE), which is gaining considerable appeal as a biomarker for secondary brain injury and clinical outcome.

Methods

Results

Conclusion