维生素 K 和非维生素 K 拮抗剂口服抗凝剂相关颅内出血的结局相似。

Similar outcomes between vitamin K and non-vitamin K antagonist oral anticoagulants associated intracerebral hemorrhage.

机构信息

Department of Neurology and Stroke Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan.

Department of Neurology and Stroke Center, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

J Formos Med Assoc. 2020 Jan;119(1 Pt 1):106-112. doi: 10.1016/j.jfma.2019.02.008. Epub 2019 Mar 12.

DOI:10.1016/j.jfma.2019.02.008

PMID:30876786

Abstract

BACKGROUND

The application of non-vitamin K antagonist oral anticoagulant (NOAC) reduces the risk of intracerebral hemorrhage (ICH) in comparison with vitamin K antagonist (VKA). However, the features and outcomes of NOAC-associated ICH are still unclear, especially for Asian populations.

METHODS

We retrospectively analyzed 49 consecutive patients who had spontaneous ICH while using NOAC or VKA. We compared the clinical characteristics, ICH volume, 7-day and 3-month mortality, and functional outcomes at discharge and 3 months post-stroke using the modified Rankin Scale (mRS) between NOAC- and VKA-associated ICH. The clinical features, ICH volume, ICH location, and/or treatment methods were statistically adjusted.

RESULTS

Among the 49 ICH patients, 15 (30.6%) were using NOAC and 34 (69.4%) were taking VKA. There were no significant differences in the initial ICH volume between groups (mean volume 34.2 ± 43.8 vs. 59.4 ± 46.5 mL, p = 0.061). The percentage of early mortality (within 7 days post-ICH) was significantly lower in the NOAC group (13.3% vs. 44.1%; p = 0.047), but the 3-month mortality was similar (33.3% vs. 47.1%; p = 0.294). The functional outcome was equally poor in both groups at discharge (p = 0.670) and 3 months post-ICH (mean mRS score 4.7 ± 1.3 vs. 4.6 ± 1.7, p = 0.766).

CONCLUSION

There were no significant differences in initial ICH volume, 90-day mortality, or functional outcomes between NOAC and VKA-associated ICH in Asians.

摘要

背景

与维生素 K 拮抗剂（VKA）相比，非维生素 K 拮抗剂口服抗凝剂（NOAC）的应用降低了颅内出血（ICH）的风险。然而，NOAC 相关 ICH 的特征和结局仍不清楚，特别是在亚洲人群中。

方法

我们回顾性分析了 49 例自发性 ICH 患者，这些患者在使用 NOAC 或 VKA 时发生了 ICH。我们比较了 NOAC 与 VKA 相关 ICH 之间的临床特征、ICH 量、7 天和 3 个月死亡率以及出院时和中风后 3 个月的功能结局，采用改良 Rankin 量表（mRS）进行评估。对临床特征、ICH 量、ICH 位置和/或治疗方法进行了统计学调整。

结果

在 49 例 ICH 患者中，15 例（30.6%）正在使用 NOAC，34 例（69.4%）正在服用 VKA。两组间初始 ICH 量无显著差异（平均量 34.2±43.8 与 59.4±46.5 ml，p=0.061）。NOAC 组早期死亡率（ICH 后 7 天内）显著较低（13.3%与 44.1%；p=0.047），但 3 个月死亡率相似（33.3%与 47.1%；p=0.294）。两组出院时（p=0.670）和中风后 3 个月（平均 mRS 评分 4.7±1.3 与 4.6±1.7，p=0.766）的功能结局同样较差。