Age-dependent clinical outcomes in primary versus oral anticoagulation-related intracerebral hemorrhage

Age-dependent clinical outcomes in primary versus oral anticoagulation-related intracerebral hemorrhage

Aims This study determined the influence of age on bleeding characteristics and clinical outcomes in primary spontaneous (non-OAC), vitamin K antagonist-related (VKA-) and non-vitamin K antagonist oral anticoagulant-related (NOAC-) ICH. Methods Pooled individual patient data of multicenter cohort st...

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Veröffentlicht in:International journal of stroke 2021-01, Vol.16 (1), p.83-92
Hauptverfasser: Sprügel, Maximilian I, Kuramatsu, Joji B, Gerner, Stefan T, Sembill, Jochen A, Madžar, Dominik, Reindl, Caroline, Bobinger, Tobias, Müller, Tamara, Hoelter, Philip, Lücking, Hannes, Engelhorn, Tobias, Huttner, Hagen B
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container_issue 1
container_start_page 83
container_title International journal of stroke
container_volume 16
creator Sprügel, Maximilian I
Kuramatsu, Joji B
Gerner, Stefan T
Sembill, Jochen A
Madžar, Dominik
Reindl, Caroline
Bobinger, Tobias
Müller, Tamara
Hoelter, Philip
Lücking, Hannes
Engelhorn, Tobias
Huttner, Hagen B
description Aims This study determined the influence of age on bleeding characteristics and clinical outcomes in primary spontaneous (non-OAC), vitamin K antagonist-related (VKA-) and non-vitamin K antagonist oral anticoagulant-related (NOAC-) ICH. Methods Pooled individual patient data of multicenter cohort studies were analyzed by logistic regression modelling and propensity-score-matching (PSM) to explore the influence of advanced age on clinical outcomes among non-OAC-, VKA-, and NOAC-ICH. Primary outcome measure was functional outcome at three months assessed by the modified Rankin Scale, dichotomized into favorable (mRS = 0–3) and unfavorable (mRS = 4–6) functional outcome. Secondary outcome measures included mortality, hematoma characteristics, and frequency of invasive interventions. Results In VKA-ICH 33.5% (670/2001), in NOAC-ICH 44.2% (69/156) and in non-OAC-ICH 25.2% (254/1009) of the patients were ≥80 years. After adjustment for treatment interventions and relevant parameters, elderly ICH patients comprised worse functional outcome at three months (adjusted odds ratio (aOR) in VKA-ICH: 1.49 (1.21–1.84); p 
doi_str_mv 10.1177/1747493019895662
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Methods Pooled individual patient data of multicenter cohort studies were analyzed by logistic regression modelling and propensity-score-matching (PSM) to explore the influence of advanced age on clinical outcomes among non-OAC-, VKA-, and NOAC-ICH. Primary outcome measure was functional outcome at three months assessed by the modified Rankin Scale, dichotomized into favorable (mRS = 0–3) and unfavorable (mRS = 4–6) functional outcome. Secondary outcome measures included mortality, hematoma characteristics, and frequency of invasive interventions. Results In VKA-ICH 33.5% (670/2001), in NOAC-ICH 44.2% (69/156) and in non-OAC-ICH 25.2% (254/1009) of the patients were ≥80 years. After adjustment for treatment interventions and relevant parameters, elderly ICH patients comprised worse functional outcome at three months (adjusted odds ratio (aOR) in VKA-ICH: 1.49 (1.21–1.84); p &lt; 0.001; NOAC-ICH: 2.01 (0.95–4.26); p = 0.069; non-OAC-ICH: 3.54 (2.50–5.03); p &lt; 0.001). Anticoagulation was significantly associated with worse functional outcome below the age of 70 years, (aOR: 2.38 (1.78–3.16); p &lt; 0.001), but not in patients of ≥70 years (aOR: 1.21 (0.89–1.65); p = 0.217). The differences in initial ICH volume and extent of ICH enlargement between OAC-ICH and non-OAC-ICH gradually decreased with increasing patient age. Conclusions As compared to elderly ICH-patients, in patients &lt;70 years OAC-ICH showed worse clinical outcomes compared to non-OAC-ICH because of larger baseline ICH-volumes and extent of hematoma enlargement. Treatment strategies aiming at neutralizing altered coagulation should be aware of these findings.</description><identifier>ISSN: 1747-4930</identifier><identifier>EISSN: 1747-4949</identifier><identifier>DOI: 10.1177/1747493019895662</identifier><identifier>PMID: 31870241</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><ispartof>International journal of stroke, 2021-01, Vol.16 (1), p.83-92</ispartof><rights>2019 World Stroke Organization</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c379t-2c1a01aea5e35a8eb1b8e985f48f418a8f0892e04c7d83dd078dde0721d3a0813</citedby><cites>FETCH-LOGICAL-c379t-2c1a01aea5e35a8eb1b8e985f48f418a8f0892e04c7d83dd078dde0721d3a0813</cites><orcidid>0000-0002-5289-3336 ; 0000-0001-9768-9630</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1747493019895662$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1747493019895662$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31870241$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sprügel, Maximilian I</creatorcontrib><creatorcontrib>Kuramatsu, Joji B</creatorcontrib><creatorcontrib>Gerner, Stefan T</creatorcontrib><creatorcontrib>Sembill, Jochen A</creatorcontrib><creatorcontrib>Madžar, Dominik</creatorcontrib><creatorcontrib>Reindl, Caroline</creatorcontrib><creatorcontrib>Bobinger, Tobias</creatorcontrib><creatorcontrib>Müller, Tamara</creatorcontrib><creatorcontrib>Hoelter, Philip</creatorcontrib><creatorcontrib>Lücking, Hannes</creatorcontrib><creatorcontrib>Engelhorn, Tobias</creatorcontrib><creatorcontrib>Huttner, Hagen B</creatorcontrib><title>Age-dependent clinical outcomes in primary versus oral anticoagulation-related intracerebral hemorrhage</title><title>International journal of stroke</title><addtitle>Int J Stroke</addtitle><description>Aims This study determined the influence of age on bleeding characteristics and clinical outcomes in primary spontaneous (non-OAC), vitamin K antagonist-related (VKA-) and non-vitamin K antagonist oral anticoagulant-related (NOAC-) ICH. Methods Pooled individual patient data of multicenter cohort studies were analyzed by logistic regression modelling and propensity-score-matching (PSM) to explore the influence of advanced age on clinical outcomes among non-OAC-, VKA-, and NOAC-ICH. Primary outcome measure was functional outcome at three months assessed by the modified Rankin Scale, dichotomized into favorable (mRS = 0–3) and unfavorable (mRS = 4–6) functional outcome. Secondary outcome measures included mortality, hematoma characteristics, and frequency of invasive interventions. Results In VKA-ICH 33.5% (670/2001), in NOAC-ICH 44.2% (69/156) and in non-OAC-ICH 25.2% (254/1009) of the patients were ≥80 years. After adjustment for treatment interventions and relevant parameters, elderly ICH patients comprised worse functional outcome at three months (adjusted odds ratio (aOR) in VKA-ICH: 1.49 (1.21–1.84); p &lt; 0.001; NOAC-ICH: 2.01 (0.95–4.26); p = 0.069; non-OAC-ICH: 3.54 (2.50–5.03); p &lt; 0.001). Anticoagulation was significantly associated with worse functional outcome below the age of 70 years, (aOR: 2.38 (1.78–3.16); p &lt; 0.001), but not in patients of ≥70 years (aOR: 1.21 (0.89–1.65); p = 0.217). The differences in initial ICH volume and extent of ICH enlargement between OAC-ICH and non-OAC-ICH gradually decreased with increasing patient age. Conclusions As compared to elderly ICH-patients, in patients &lt;70 years OAC-ICH showed worse clinical outcomes compared to non-OAC-ICH because of larger baseline ICH-volumes and extent of hematoma enlargement. 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Methods Pooled individual patient data of multicenter cohort studies were analyzed by logistic regression modelling and propensity-score-matching (PSM) to explore the influence of advanced age on clinical outcomes among non-OAC-, VKA-, and NOAC-ICH. Primary outcome measure was functional outcome at three months assessed by the modified Rankin Scale, dichotomized into favorable (mRS = 0–3) and unfavorable (mRS = 4–6) functional outcome. Secondary outcome measures included mortality, hematoma characteristics, and frequency of invasive interventions. Results In VKA-ICH 33.5% (670/2001), in NOAC-ICH 44.2% (69/156) and in non-OAC-ICH 25.2% (254/1009) of the patients were ≥80 years. After adjustment for treatment interventions and relevant parameters, elderly ICH patients comprised worse functional outcome at three months (adjusted odds ratio (aOR) in VKA-ICH: 1.49 (1.21–1.84); p &lt; 0.001; NOAC-ICH: 2.01 (0.95–4.26); p = 0.069; non-OAC-ICH: 3.54 (2.50–5.03); p &lt; 0.001). Anticoagulation was significantly associated with worse functional outcome below the age of 70 years, (aOR: 2.38 (1.78–3.16); p &lt; 0.001), but not in patients of ≥70 years (aOR: 1.21 (0.89–1.65); p = 0.217). The differences in initial ICH volume and extent of ICH enlargement between OAC-ICH and non-OAC-ICH gradually decreased with increasing patient age. Conclusions As compared to elderly ICH-patients, in patients &lt;70 years OAC-ICH showed worse clinical outcomes compared to non-OAC-ICH because of larger baseline ICH-volumes and extent of hematoma enlargement. Treatment strategies aiming at neutralizing altered coagulation should be aware of these findings.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>31870241</pmid><doi>10.1177/1747493019895662</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-5289-3336</orcidid><orcidid>https://orcid.org/0000-0001-9768-9630</orcidid><oa>free_for_read</oa></addata></record>
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title Age-dependent clinical outcomes in primary versus oral anticoagulation-related intracerebral hemorrhage
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