Department of Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
Acta Neurol Scand. 2022 Nov;146(5):590-597. doi: 10.1111/ane.13685. Epub 2022 Aug 16.
We aimed to describe baseline characteristics of patients with oral anticoagulant-related intracerebral hemorrhage (OAC-ICH) in Sweden and to identify predictive variables associated with receiving hemostatic treatment in the event of OAC-ICH.
We performed an observational study based on data from Riksstroke and the Swedish Causes of Death Register to define baseline characteristics of patients with OAC-ICH who received reversal treatment compared with patients who did not receive reversal treatment during 2017-2019. Predictive analysis was performed using multivariable logistic regression to identify odds ratios for factors associated with receiving OAC reversal treatment.
We included 1902 patients ((n = 1146; OAC reversal treatment) (n = 756; no OAC reversal treatment)). The proportion of non-Vitamin K oral anticoagulant associated ICH (NOAC-ICH) patients who received reversal treatment was 48.4% and the proportion of Vitamin K antagonist-associated ICH (VKA-ICH) patients was 72.9%. Factors associated with a lower odds of receiving reversal treatment were increased age (OR = 0.98; 95% CI: 0.96-0.99), previous stroke (OR = 0.78; 95% CI: 0.62-0.98), comatose LOC (OR = 0.36;95%CI: 0.27-0.48; ref. = alert), pre-stroke dependency (OR = 0.72; 95% CI: 0.58-0.91), and NOAC treatment (OR = 0.34; 95% CI: 0.28-0.42). Care at a university hospital was not associated with higher odds of receiving reversal treatment compared to treatment at a county hospital.
Treatment with a reversal agent following OAC-ICH was related to several patient factors including type of OAC drug. We identified that only 48% of patients with NOAC-ICH received hemostatic treatment despite an increase in these cases. Further studies are required to guide the use of reversal therapies more precisely, particularly in NOAC-ICH.
本研究旨在描述瑞典口服抗凝剂相关脑出血（OAC-ICH）患者的基线特征，并确定与 OAC-ICH 发生时接受止血治疗相关的预测变量。
我们进行了一项观察性研究，基于 Riksstroke 和瑞典死因登记处的数据，以定义 2017-2019 年期间接受逆转治疗的 OAC-ICH 患者与未接受逆转治疗的患者的基线特征。采用多变量逻辑回归进行预测分析，以确定与接受 OAC 逆转治疗相关的因素的优势比。
我们纳入了 1902 名患者（n=1146；接受 OAC 逆转治疗）（n=756；未接受 OAC 逆转治疗）。接受逆转治疗的非维生素 K 口服抗凝剂相关脑出血（NOAC-ICH）患者比例为 48.4%，维生素 K 拮抗剂相关脑出血（VKA-ICH）患者比例为 72.9%。与接受逆转治疗的可能性较低相关的因素包括年龄增加（OR=0.98；95%CI：0.96-0.99）、既往卒中（OR=0.78；95%CI：0.62-0.98）、昏迷 LOC（OR=0.36；95%CI：0.27-0.48；参考=警觉）、卒中前依赖（OR=0.72；95%CI：0.58-0.91）和 NOAC 治疗（OR=0.34；95%CI：0.28-0.42）。与在县医院治疗相比，在大学医院接受治疗与接受逆转治疗的可能性更高无关。
OAC-ICH 后使用逆转剂治疗与包括 OAC 药物类型在内的多种患者因素有关。我们发现，尽管这些病例有所增加，但只有 48%的 NOAC-ICH 患者接受了止血治疗。需要进一步的研究来更准确地指导逆转治疗的使用，特别是在 NOAC-ICH 中。
