Association of oral anticoagulants with risk of brain haemorrhage expansion compared to no-anticoagulation.

IF 3.2 Q2 Medicine Neurological research and practice Pub Date : 2025-02-12 DOI:10.1186/s42466-024-00358-9

Roland Veltkamp, Kirsten Haas, Viktoria Rücker, Uwe Malzahn, Adrian Heeger, David Kinzler, Patrick Müller, Pascal Rappard, Timolaos Rizos, Johannes Schiefer, Christian Opherk, Waltraud Pfeilschifter, Katharina Althaus, Peter Schellinger, Bernadette Gaida, Maria Magdalena Gabriel, Georg Royl, Darius G Nabavi, Karl Georg Haeusler, Christian H Nolte, Marc E Wolf, Sven Poli, Marilen Sieber, Pascal Mosimann, Peter U Heuschmann, Jan C Purrucker

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Abstract

Background: The impact of direct oral anticoagulants (DOAC) on haematoma size after intracerebral haemorrhage (ICH) compared to no-anticoagulation is controversial and prospective data are lacking.

Methods: The investigator-initiated, multicentre, prospective RASUNOA-prime study enrolled patients with non-traumatic ICH and atrial fibrillation while on a DOAC, vitamin K antagonist (VKA) or no anticoagulation (non-OAC). Neuroimaging was reviewed centrally blinded to group allocation. Primary endpoint was haematoma expansion (≥ 6.5 ml or ≥ 33%, any new intraventricular blood or an increase in modified Graeb score by ≥ 2 points) between baseline and follow-up scan within 72 h after symptom onset.

Results: Of 1,440 patients screened, 951 patients with ICH symptom onset less than 24 h before admission were enrolled. Baseline scans were performed at a median of 2 h (IQR 1-6) after symptom onset. Neurological deficit and median baseline haematoma volumes (11 ml; IQR 4-39) did not differ among 577 DOAC, 251 VKA and 123 non-OAC patients. Haematoma expansion was observed in DOAC patients in 142/356 (39.9, 95%-CI 34.8-45.0%), VKA in 47/155 (30.3, 95-CI 23.1%-37.6%), versus non-OAC in 22/74 (29.7, 19.3-40.1%). Unspecific reversal agents in DOAC-ICH (212/356, 59.6%) did not affect the haematoma expansion rate compared to no-antagonization.

Conclusion: Baseline haematoma volume and risk of haematoma expansion did not differ statistically significantly in patients with and without DOAC.

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与不使用抗凝剂相比，口服抗凝剂与脑出血扩张风险的关系。

背景：与不抗凝相比，直接口服抗凝剂（DOAC）对脑出血（ICH）后血肿大小的影响存在争议，且缺乏前瞻性数据。方法：研究者发起的多中心前瞻性rasunoa研究纳入了服用DOAC、维生素K拮抗剂（VKA）或不服用抗凝剂（非oac）的非创伤性脑出血和房颤患者。神经影像学检查采用中心盲法进行分组。主要终点是在症状出现后72小时内，基线和随访扫描之间的血肿扩张（≥6.5 ml或≥33%，任何新的脑室血液或改良Graeb评分增加≥2分）。结果：在筛选的1440例患者中，951例入院前症状发作时间小于24小时的患者入组。基线扫描在症状出现后2小时（IQR 1-6）进行。神经功能缺损和基线血肿中位数(11 ml；577例DOAC、251例VKA和123例非oac患者的IQR（4-39）无差异。DOAC患者血肿扩张的发生率为142/356 (39.9,95%-CI 34.8-45.0%)， VKA的发生率为47/155 (30.3,95-CI 23.1%-37.6%)，而非oac患者的血肿扩张发生率为22/74（29.7,19.3-40.1%）。与无拮抗相比，DOAC-ICH非特异性逆转药物（212/356,59.6%）不影响血肿扩张率。结论：基线血肿体积和血肿扩张风险在DOAC患者和非DOAC患者中无统计学差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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