DiRisio Aislyn C, Harary Maya, Muskens Ivo S, Yunusa Ismaeel, Gormley William B, Aglio Linda S, Smith Timothy R, Connors Jean M, Mekary Rania A, Broekman Marike L D
Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Clin Neurosci. 2019 Apr;62:188-194. doi: 10.1016/j.jocn.2018.11.032. Epub 2018 Nov 22.
Direct Oral Anticoagulants (DOAC) are increasingly used as an alternative to vitamin-K antagonists (VKA) for anticoagulation and have shown lower rates of intracranial hemorrhage; however, there is disagreement in the literature over the outcomes of the intraparenchymal hemorrhages (IPH) associated with DOACs, and clinical concern regarding the lack of standardized reversal strategies for DOACs. Thus, the aim of this meta-analysis was to compare mortality, hematoma volume, and risk of hematoma expansion in patients who developed an IPH on DOACs versus VKA. A systematic review of the literature was conducted in accordance with the PRISMA guidelines. Studies were selected that reported on mortality, hematoma expansion, and hematoma volume in DOAC-associated IPH. Pooled risk ratios (RR) were calculated for mortality and hematoma expansion and pooled mean difference (MD) was calculated for hematoma volume (ml) using random-effect models. 15 studies reporting on 1238 patients were included in the systematic review. Eleven of these compared DOAC-IPH to VKA-IPH and were pooled quantitatively. DOAC-IPH was not associated with increased mortality risk (RR: 0.95, 95%-CI: 0.72 -1.27) or increased hematoma expansion risk (RR: 0.92; 95%-CI: 0.75-1.12) compared to VKA-IPH. The hematoma volume of DOAC- IPH was statistically significantly smaller than VKA-IPH (MD: -12.14 ml; 95%-CI: -15.38; -8.89). In conclusion, DOAC-IPH was not associated with increased mortality or hematoma expansion compared to VKA-IPH and may be associated with a smaller hematoma volume.
直接口服抗凝剂（DOAC）越来越多地被用作维生素K拮抗剂（VKA）进行抗凝的替代药物，且已显示出较低的颅内出血发生率；然而，关于与DOAC相关的脑实质内出血（IPH）的结果，文献中存在分歧，并且对于DOAC缺乏标准化的逆转策略存在临床担忧。因此，本荟萃分析的目的是比较服用DOAC与VKA后发生IPH的患者的死亡率、血肿体积和血肿扩大风险。按照PRISMA指南对文献进行了系统评价。选择了报告DOAC相关IPH的死亡率、血肿扩大和血肿体积的研究。使用随机效应模型计算死亡率和血肿扩大的合并风险比（RR），并计算血肿体积（ml）的合并平均差（MD）。系统评价纳入了15项报告1238例患者的研究。其中11项将DOAC-IPH与VKA-IPH进行了比较，并进行了定量汇总。与VKA-IPH相比，DOAC-IPH与死亡风险增加（RR：0.95，95%置信区间：0.72-1.27）或血肿扩大风险增加（RR：0.92；95%置信区间：0.7
