Department of Neuroradiology, Université Paris-Descartes, Centre Hospitalier Sainte Anne, Paris, Ile de France, France.
Department of Emergency Neurology, Stroke Unit, C. Mondino National Neurological Institute, Pavia, Italy.
J Neurol Neurosurg Psychiatry. 2018 Mar;89(3):263-270. doi: 10.1136/jnnp-2017-316631. Epub 2017 Oct 13.
The characteristics and natural history of acute non-vitamin K antagonists oral anticoagulants (NOAC)-associated intracerebral haemorrhage (ICH) are largely unknown. We performed a comprehensive systematic review and meta-analysis to compare baseline ICH volume, haematoma expansion and clinical outcomes between NOAC-ICH versus vitamin K antagonists-ICH (VKA-ICH).
We searched PubMed and conference abstracts for observational studies comparing baseline characteristics and outcomes in patients with NOAC-ICH versus VKA-ICH using an appropriate keyword/MeSH term search strategy. Data were extracted following PRISMA and MOOSE guidelines. The main outcome measures were mortality and unfavourable functional outcome (modified Rankin Score: 4-6) at discharge and at 3 months, as well as ICH volumes and haematoma expansion rates in the two groups. Random-effects models with DerSimonian-Laird weights were used for pooled estimates calculation.
Twelve studies including 393 NOAC-ICH and 3482 VKA-ICH were pooled in meta-analysis. There was no difference in mean ICH-volume between the two groups (standard mean difference: -0.24; 95% CI -0.52 to 0.04, p=0.093). The rates of haematoma expansion were comparable in NOAC-ICH versus VKA-ICH (OR: 0.76; 95% CI 0.49 to 1.19, p=0.236). We did not find any difference between patients with NOAC-ICH versus VKA-ICH in all-cause mortality at discharge (OR: 0.66; 95% CI 0.42 to 1.05, p=0.077) and unfavourable functional outcome at discharge (OR: 0.77; 95% CI 0.41 to 1.44, p=0.413). The 3-month outcome was also comparable between the two ICH groups. Moderate-to-substantial statistical heterogeneity was noted.
Our results confirm that ICH volume, haematoma expansion, mortality and functional outcome appear to be similar for NOAC-ICH versus VKA-ICH. Large prospective cohorts and updated meta-analyses are needed to provide more precise estimates.
急性非维生素 K 拮抗剂口服抗凝剂（NOAC）相关脑出血（ICH）的特征和自然史在很大程度上尚不清楚。我们进行了全面的系统评价和荟萃分析，以比较 NOAC-ICH 与维生素 K 拮抗剂-ICH（VKA-ICH）之间的基线 ICH 体积、血肿扩大和临床结局。
我们使用适当的关键字/ MeSH 术语搜索策略，在 PubMed 和会议摘要中搜索比较使用 NOAC-ICH 与 VKA-ICH 的患者基线特征和结局的观察性研究。按照 PRISMA 和 MOOSE 指南提取数据。主要结局测量指标为两组患者出院时和 3 个月时的死亡率和不良功能结局（改良 Rankin 评分：4-6），以及两组的 ICH 体积和血肿扩大率。使用 DerSimonian-Laird 权重的随机效应模型计算汇总估计值。
荟萃分析共纳入 12 项研究，包括 393 例 NOAC-ICH 和 3482 例 VKA-ICH。两组 ICH 体积无差异（标准均数差：-0.24；95%CI-0.52 至 0.04，p=0.093）。NOAC-ICH 与 VKA-ICH 血肿扩大率相当（OR：0.76；95%CI 0.49 至 1.19，p=0.236）。我们没有发现 NOAC-ICH 与 VKA-ICH 患者在出院时的全因死亡率（OR：0.66；95%CI 0.42 至 1.05，p=0.077）和出院时不良功能结局（OR：0.77；95%CI 0.41 至 1.44，p=0.413）方面有差异。两组 ICH 患者 3 个月的结局也相当。注意到存在中度至高度统计学异质性。
我们的结果证实，NOAC-ICH 与 VKA-ICH 的 ICH 体积、血肿扩大、死亡率和功能结局似乎相似。需要大型前瞻性队列和更新的荟萃分析来提供更准确的估计。
