Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
J Stroke Cerebrovasc Dis. 2019 Oct;28(10):104292. doi: 10.1016/j.jstrokecerebrovasdis.2019.07.008. Epub 2019 Jul 30.
Decisions regarding whether and when to resume direct oral anticoagulants (DOAC) after acute intracerebral hemorrhage (ICH) are challenging. We examined the timing of DOAC resumption and factors that influence decision-making in DOAC resumption.
We retrospectively analyzed 43 patients with ICH who were treated with DOAC for nonvalvular atrial fibrillation before ICH onset. All patients were divided into 2 groups (resumption of DOAC and no resumption of DOAC) during hospitalization. Clinical backgrounds, laboratory data, and stroke severity were compared between the groups.
DOAC were resumed in 19 of 39 (49%) acute ICH survivors and were not resumed in 24 patients, including 4 deceased patients. The National Institutes of Health Stroke Scale score at admission tended to be higher in the no resumption group (median, 17) than in the resumption group (median, 6) (P = .119). The modified Rankin Scale score was slightly poorer in the no resumption group (median, 4) than in the resumption group (median, 3) (P = .070). In the resumption group, DOAC were resumed at a median of 11 days (interquartile range, 5-21 days) after ICH onset. The modified Rankin Scale score at discharge was positively correlated with the days of DOAC resumption (R = .31, P = .013).
In half of patients, DOAC were resumed relatively early after ICH onset. Early resumption of DOAC for ICH in patients with nonvalvular atrial fibrillation is considered to be safe. The functional outcome was associated with not only resumption of DOAC but also the timing of resumption.
急性脑出血（ICH）后是否以及何时恢复直接口服抗凝剂（DOAC）的决策具有挑战性。我们研究了 DOAC 恢复的时间以及影响 DOAC 恢复决策的因素。
我们回顾性分析了 43 例在 ICH 发病前因非瓣膜性心房颤动而接受 DOAC 治疗的 ICH 患者。所有患者在住院期间均分为 2 组（恢复 DOAC 和不恢复 DOAC）。比较两组的临床背景、实验室数据和卒中严重程度。
在 39 例急性 ICH 幸存者中，19 例（49%）恢复了 DOAC，24 例未恢复，其中 4 例死亡。未恢复组入院时国立卫生研究院卒中量表评分（中位数 17）高于恢复组（中位数 6）（P=.119）。未恢复组改良 Rankin 量表评分（中位数 4）略差于恢复组（中位数 3）（P=.070）。在恢复组，DOAC 在 ICH 发病后中位数 11 天（四分位距 5-21 天）恢复。出院时改良 Rankin 量表评分与 DOAC 恢复天数呈正相关（R=.31，P=.013）。
在一半的患者中，DOAC 在 ICH 发病后相对较早恢复。考虑到非瓣膜性心房颤动患者 ICH 后早期恢复 DOAC 是安全的。功能结局不仅与 DOAC 的恢复有关，还与恢复的时间有关。
