Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany.
Neurocrit Care. 2017 Oct;27(2):208-213. doi: 10.1007/s12028-017-0403-x.
Intracerebral hemorrhage (ICH) is a life-threatening complication of non-vitamin K antagonist oral anticoagulants (NOAC). Little is known about the effect of intensity of anticoagulation on NOAC-ICH. We describe the current use of coagulation testing in the emergency setting and explore associations with baseline size and expansion of hematoma as determined in a previous study.
Data from the prospective multicenter RASUNOA registry were analyzed. Patients with NOAC-ICH were enrolled between February 2012 and December 2014. Frequency of local test performance of specific (anti-factor Xa tests, diluted thrombin time) and non-specific tests (international normalized ratio (INR), activated partial thromboplastin time (aPTT), thrombin time) was analyzed. The association of anticoagulation intensity at admission with hematoma volume and hematoma expansion was explored.
In 61 NOAC-ICH patients enrolled at 21 centers, drug-specific coagulation testing was performed in 16 cases (26%), and only 29% of centers appeared to use drug-specific tests in NOAC-ICH at all. In some cases, INR and aPTT values were normal despite drug concentrations in the peak range. In patients with available drug-specific concentrations, 50% had drug levels in the peak range at admission. Higher intensity of anticoagulation was not associated with higher hematoma volume at admission or with subsequent hematoma expansion.
Drug-specific tests are only infrequently used in NOAC-ICH. Normal results in non-specific coagulation do not reliably rule out peak range concentrations. Anticoagulation intensity at admission does not predict baseline hematoma volume or subsequent hematoma expansion.
颅内出血（ICH）是非维生素 K 拮抗剂口服抗凝剂（NOAC）的一种危及生命的并发症。关于抗凝强度对 NOAC-ICH 的影响知之甚少。我们描述了目前在急诊环境中凝血检测的使用情况，并探讨了与之前研究中确定的基线血肿大小和扩大的相关性。
分析了前瞻性多中心 RASUNOA 登记处的数据。2012 年 2 月至 2014 年 12 月期间，招募了接受 NOAC-ICH 的患者。分析了特定（抗因子 Xa 检测、稀释凝血酶时间）和非特异性（国际标准化比值（INR）、活化部分凝血活酶时间（aPTT）、凝血酶时间）检测的局部检测频率。探讨了入院时抗凝强度与血肿量和血肿扩大的关系。
在 21 个中心招募的 61 名 NOAC-ICH 患者中，有 16 例（26%）进行了药物特异性凝血检测，只有 29%的中心在所有 NOAC-ICH 中似乎都使用了药物特异性检测。在某些情况下，尽管药物浓度处于峰值范围，但 INR 和 aPTT 值正常。在有可用药物特异性浓度的患者中，50%的患者在入院时药物水平处于峰值范围。较高的抗凝强度与入院时较高的血肿量或随后的血肿扩大无关。
药物特异性检测在 NOAC-ICH 中很少使用。非特异性凝血的正常结果不能可靠地排除峰值范围的浓度。入院时的抗凝强度不能预测基线血肿量或随后的血肿扩大。
