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Published on: June 18, 2021
Hematoma growth in oral anticoagulant related intracerebral hemorrhage
Brett Cucchiara1, Steven Messe, Lauren Sansing
1Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. cucchiar@mail.med.upenn.edu
Background And Purpose:
Limited data suggest that intracerebral hemorrhage related to oral anticoagulant therapy (OAT ICH) is associated with more hemorrhage expansion and a worse prognosis than spontaneous ICH (SICH).
Methods:
We examined patients enrolled in the placebo arm of the CHANT study, a prospective randomized trial of a putative neuroprotectant in patients with ICH. All patients had neuroimaging within 6 hours of symptom onset and at 72 hours. Initial ICH volume and hemorrhage expansion were determined by a central reader. Multivariable logistic regression was used to determine factors associated with ICH expansion and mortality at 90 days.
Results:
Of 303 patients included, 21 (6.9%) had OAT ICH. Baseline median ICH volume was greater in patients with OAT ICH compared to SICH (30.6 versus 14.4 mL, P=0.03). Hemorrhage expansion (defined as >33% increase in ICH volume) occurred in 56% of patients with OAT ICH compared to 26% of SICH (P=0.006). Mortality was substantially higher in OAT ICH (62% versus 17%, P<0.001). In multivariable analysis, time to neuroimaging and oral anticoagulant use were independently associated with hemorrhage expansion, and age, gender, and oral anticoagulant use were independently associated with mortality.
Conclusions:
These findings confirm that OAT ICH is associated with more hemorrhage expansion and greater mortality than SICH.
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