Age-dependent clinical outcomes in primary versus oral anticoagulation-related intracerebral hemorrhage. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Sprügel, Maximilian I; Kuramatsu, Joji B; Gerner, Stefan T; Sembill, Jochen A; Madžar, Dominik; Reindl, Caroline; Bobinger, Tobias; Müller, Tamara; Hoelter, Philip; Lücking, Hannes; Engelhorn, Tobias; Huttner, Hagen B
• Is Part Of: International journal of stroke. Volume 16:Issue 1(2021)
• Page Start: 83
• Page End: 92
• Publication Date: 2021-01
• Subjects: Intracerebral hemorrhage -- intracranial hemorrhage -- age -- anticoagulation; 616.8005
• DOI: 10.1177/1747493019895662
• Languages: English
• ISSNs: 1747-4930

Abstract

Aims: This study determined the influence of age on bleeding characteristics and clinical outcomes in primary spontaneous (non-OAC), vitamin K antagonist-related (VKA-) and non-vitamin K antagonist oral anticoagulant-related (NOAC-) ICH. Methods: Pooled individual patient data of multicenter cohort studies were analyzed by logistic regression modelling and propensity-score-matching (PSM) to explore the influence of advanced age on clinical outcomes among non-OAC-, VKA-, and NOAC-ICH. Primary outcome measure was functional outcome at three months assessed by the modified Rankin Scale, dichotomized into favorable (mRS = 0–3) and unfavorable (mRS = 4–6) functional outcome. Secondary outcome measures included mortality, hematoma characteristics, and frequency of invasive interventions. Results: In VKA-ICH 33.5% (670/2001), in NOAC-ICH 44.2% (69/156) and in non-OAC-ICH 25.2% (254/1009) of the patients were ≥80 years. After adjustment for treatment interventions and relevant parameters, elderly ICH patients comprised worse functional outcome at three months (adjusted odds ratio (aOR) in VKA-ICH: 1.49 (1.21–1.84); p < 0.001; NOAC-ICH: 2.01 (0.95–4.26); p = 0.069; non-OAC-ICH: 3.54 (2.50–5.03); p < 0.001). Anticoagulation was significantly associated with worse functional outcome below the age of 70 years, (aOR: 2.38 (1.78–3.16); p < 0.001), but not in patients of ≥70 years (aOR: 1.21 (0.89–1.65); p = 0.217). The differences in initial ICH volume and extent of ICH enlargement between OAC-ICH and non-OAC-ICH gradually decreased with increasing patient age. Conclusions: As compared to elderly ICH-patients, in patients <70 years OAC-ICH showed worse clinical outcomes compared to non-OAC-ICH because of larger baseline ICH-volumes and extent of hematoma enlargement. Treatment strategies aiming at neutralizing altered coagulation should be aware of these findings.