Melmed Kara R, Lyden Patrick, Gellada Norman, Moheet Asma
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California.
J Stroke Cerebrovasc Dis. 2017 Aug;26(8):1874-1882. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.025. Epub 2017 Jun 21.
Non-vitamin K antagonist oral anticoagulant (NOAC) use has significantly reduced intracerebral hemorrhagic (ICH) risk compared with standard anticoagulant treatment. Hematoma expansion (HE) is a known predictor of mortality in warfarin-associated ICH. Little is known about HE in patients using NOACs.
We conducted a retrospective chart review of patients with ICH admitted to Cedars-Sinai Medical Center from October 2010 to June 2016. We identified patients with concomitant administration of an oral anticoagulant and collected data including evidence of HE on imaging and modified Rankin Scale (mRS) at discharge. We defined HE as relative (≥33% increase) or absolute expansion (≥12 mL). We compared outcomes of patients with and without HE.
Out of 814 patients with ICH who were admitted, we identified 9 patients with recent NOAC use and 18 intentionally matched controls on warfarin. We found no significant differences in National Institutes of Health Stroke Scale or ICH score on presentation (median [interquartile range] 15 [5,21] versus 7 [1.25,19.5] [P = .41] and 2 [1,4] versus 1 [1,3] [P = .33]) between patients on NOACs and those on warfarin. Four out of the 9 patients on NOAC and 5 of the 18 patients on warfarin demonstrated HE, with no significant difference (P = .42). There were no significant differences in mRS on discharge between groups (P = .52).
In our coagulopathic NOAC patient population, HE occurs within 6 hours in 44% of patients. This case series did not have sufficient statistical power to detect significant differences between the groups. To our knowledge, this is one of the largest case series reporting on HE with concomitant NOAC use.
与标准抗凝治疗相比，使用非维生素K拮抗剂口服抗凝药（NOAC）可显著降低颅内出血（ICH）风险。血肿扩大（HE）是华法林相关ICH患者死亡率的已知预测指标。对于使用NOAC的患者，关于HE的情况知之甚少。
我们对2010年10月至2016年6月入住雪松西奈医疗中心的ICH患者进行了回顾性病历审查。我们确定了同时使用口服抗凝药的患者，并收集了包括影像学上HE的证据以及出院时改良Rankin量表（mRS）的数据。我们将HE定义为相对扩大（增加≥33%）或绝对扩大（≥12毫升）。我们比较了有和没有HE的患者的结局。
在814例入院的ICH患者中，我们确定了9例近期使用NOAC的患者和18例故意匹配的华法林对照患者。我们发现，使用NOAC的患者与使用华法林的患者在入院时的美国国立卫生研究院卒中量表或ICH评分上没有显著差异（中位数[四分位间距]分别为15[5,21]对7[1.25,19.5][P = 0.41]和2[1,4]对1[1,3][P = 0.33]）。9例使用NOAC的患者中有4例以及18例使用华法林的患者中有5例出现HE，差异无统计学意义（P = 0.42）。两组之间出院时的mRS没有显著差异（P = 0.52）。
在我们患有凝血病的NOAC患者群体中，44%的患者在6小时内发生HE。该病例系列没有足够的统计效力来检测组间的显著差异。据我们所知，这是关于同时使用NOAC时HE的最大病例系列之一。
