Association of prothrombin complex concentrate administration and hematoma enlargement in non–vitamin K antagonist oral anticoagulant–related intracerebral hemorrhage. Issue 1 (24th January 2018)

• Record Type: Journal Article
• Authors: Gerner, Stefan T.; Kuramatsu, Joji B.; Sembill, Jochen A.; Sprügel, Maximilian I.; Endres, Matthias; Haeusler, Karl Georg; Vajkoczy, Peter; Ringleb, Peter A.; Purrucker, Jan; Rizos, Timolaos; Erbguth, Frank; Schellinger, Peter D.; Fink, Gereon R.; Stetefeld, Henning; Schneider, Hauke; Neugebauer, Hermann; Röther, Joachim; Claßen, Joseph; Michalski, Dominik; Dörfler, Arnd; Schwab, Stefan; Huttner, Hagen B.
• Other Names: Horn Markus investigator.; Bahner Dirk investigator.; Hagemann Georg investigator.; Rakers Florian investigator.; Endres Matthias investigator.; Haeusler Karl Georg investigator.; Sobesky Jan investigator.; Schurig Johannes investigator.; Zweynert Sarah investigator.; Bauer Miriam investigator.; Vajkoczy Peter investigator.; Fink Gereon R. investigator.; Dohmen Christian investigator.; Stetefeld Henning investigator.; Schwarz Michael investigator.; Reimann Gernot investigator.; Reichmann Heinz investigator.; Schneider Hauke investigator.; Rahmig Jan investigator.; Gerner Stefan T. investigator.; Kuramatsu Joji B. investigator.; Bogenreuther Christina investigator.; Sembill Jochen A. investigator.; Sprügel Maximilian I. investigator.; Hagen Manuel investigator.; Knappe Ruben investigator.; Köhrmann Martin investigator.; Schwab Stefan investigator.; Huttner Hagen B. investigator.; Kloska Stephan P. investigator.; Dörfler Arnd investigator.; Ringwald Jürgen investigator.; Hamann Gerhard F. investigator.; Röther Joachim investigator.; Michels Peter investigator.; Ringleb Peter A. investigator.; Purrucker Jan investigator.; Rizos Timolaos investigator.; Witte Otto W. investigator.; Günther Albrecht investigator.; Wöhrle Johannes C. investigator.; Alshammari Fahid investigator.; Claßen Joseph investigator.; Michalski Dominik investigator.; Grau Armin investigator.; Palm Frederick investigator.; Urbanek Christian investigator.; Schellinger Peter D. investigator.; Glahn Jörg investigator.; Knappe Ulrich J. investigator.; Wiendl Heinz investigator.; Fisse Anna Lena investigator.; Minnerup Jens investigator.; Erbguth Frank investigator.; Nueckel Martin investigator.; Bäzner Hansjörg investigator.; Schwert Henning investigator.; Ludolph Albert Christian investigator.; Stösser Sebastian investigator.; Neugebauer Hermann investigator.; Volkmann Jens investigator.; Müllges Wolfgang investigator.; Kraft Peter investigator.; Schubert Anna‐Lena investigator.;
• Is Part Of: Annals of neurology. Volume 83:Issue 1(2018)
• Page Start: 186
• Page End: 196
• Publication Date: 2018-01-24
• Subjects: Neurology -- Periodicals; Pediatric neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; 616.8
• DOI: 10.1002/ana.25134
• Languages: English
• ISSNs: 0364-5134

Abstract

Abstract : Objective: To investigate parameters associated with hematoma enlargement in non–vitamin K antagonist oral anticoagulant (NOAC)‐related intracerebral hemorrhage (ICH). Methods: This retrospective cohort study includes individual patient data for 190 patients with NOAC‐associated ICH over a 5‐year period (2011–2015) at 19 departments of neurology across Germany. Primary outcome was the association of prothrombin complex concentrate (PCC) administration with hematoma enlargement. Subanalyses were calculated for blood pressure management and its association with the primary outcome. Secondary outcomes include associations with in‐hospital mortality and functional outcome at 3 months assessed using the modified Rankin Scale. Results: The study population for analysis of primary and secondary outcomes consisted of 146 NOAC‐ICH patients with available follow‐up imaging. Hematoma enlargement occurred in 49/146 (33.6%) patients with NOAC‐related ICH. Parameters associated with hematoma enlargement were blood pressure ≥ 160mmHg within 4 hours and—in the case of factor Xa inhibitor ICH—anti‐Xa levels on admission. PCC administration prior to follow‐up imaging was not significantly associated with a reduced rate of hematoma enlargement either in overall NOAC‐related ICH or in patients with factor Xa inhibitor intake (NOAC: risk ratio [RR] = 1.150, 95% confidence interval [CI] = 0.632–2.090; factor Xa inhibitor: RR = 1.057, 95% CI = 0.565–1.977), regardless of PCC dosage given or time interval until imaging or treatment. Systolic blood pressure levels < 160mmHg within 4 hours after admission were significantly associated with a reduction in the proportion of patients with hematoma enlargement (RR = 0.598, 95% CI = 0.365–0.978). PCC administration had no effect on mortality and functional outcome either at discharge or at 3 months. Interpretation: In contrast to blood pressure control, PCC administration was not associated with a reduced rate of hematoma enlargement in NOAC‐related ICH. Our findings support the need of further investigations exploring new hemostatic reversal strategies for patients with factor Xa inhibitor–related ICH. Ann Neurol 2018;83:186–196