Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin

Ryota Kurogi, Kunihiro Nishimura, Michikazu Nakai, Akiko Kada, Satoru Kamitani, Jyoji Nakagawara, Kazunori Toyoda, Kuniaki Ogasawara, Junichi Ono, Yoshiaki Shiokawa, Toru Aruga, Shigeru Miyachi, Izumi Nagata, Shinya Matsuda, Shinichi Yoshimura, Kazuo Okuchi, Akifumi Suzuki, Fumiaki Nakamura, Daisuke Onozuka, Keisuke IdoAi Kurogi, Nobutaka Mukae, Ataru Nishimura, Koichi Arimura, Takanari Kitazono, Akihito Hagihara, Koji Iihara

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Abstract

Objectives This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)-associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database. Methods We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC-and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge. Results DOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039). Conclusions This nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.

Original languageEnglish
Pages (from-to)e1143-e1149
JournalNeurology
Volume90
Issue number13
DOIs
Publication statusPublished - Mar 27 2018

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All Science Journal Classification (ASJC) codes

  • Clinical Neurology

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Kurogi, R., Nishimura, K., Nakai, M., Kada, A., Kamitani, S., Nakagawara, J., ... Iihara, K. (2018). Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin. Neurology, 90(13), e1143-e1149. https://doi.org/10.1212/WNL.0000000000005207