Absolute perihematomal edema was an independent predictor of poor clinical outcome in NON-OAC-ICH (OR 1.02; 95% CI 1.002-1.028; p=0.027), but not in OAC-associated intracerebral hemorrhage (p=0.45).
Cohort (n=811)
Yes
Does oral anticoagulant use affect perihematomal edema and clinical outcomes in patients with intracerebral hemorrhage?
Early perihematomal edema is less pronounced in OAC-associated intracerebral hemorrhage compared to non-OAC ICH, and its volume predicts poor functional outcome only in non-OAC ICH.
Effect estimate: OR 1.02 (95% CI 1.002-1.028)
p-value: p=0.027
Background: There is a need to examine the effects of different types of oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) on perihematomal edema (PHE), which is gaining considerable appeal as a biomarker for secondary brain injury and clinical outcome. Methods: In a large multicenter approach, computed tomography-derived imaging markers for PHE (absolute PHE, relative PHE (rPHE), edema expansion distance (EED)) were calculated for patients with OAC-ICH and NON-OAC-ICH. Exploratory analysis for non-vitamin-K-antagonist OAC (NOAC) and vitamin-K-antagonists (VKA) was performed. The predictive performance of logistic regression models, employing predictors of poor functional outcome (modified Rankin scale 4–6), was explored. Results: Of 811 retrospectively enrolled patients, 212 (26.14%) had an OAC-ICH. Mean rPHE and mean EED were significantly lower in patients with OAC-ICH compared to NON-OAC-ICH, p-value 0.001 and 0.007; whereas, mean absolute PHE did not differ, p-value 0.091. Mean EED was also significantly lower in NOAC compared to NON-OAC-ICH, p-value 0.05. Absolute PHE was an independent predictor of poor clinical outcome in NON-OAC-ICH (OR 1.02; 95%CI 1.002–1.028; p-value 0.027), but not in OAC-ICH (p-value 0.45). Conclusion: Quantitative markers of early PHE (rPHE and EED) were lower in patients with OAC-ICH compared to those with NON-OAC-ICH, with significantly lower levels of EED in NOAC compared to NON-OAC-ICH. Increase of early PHE volume did not increase the likelihood of poor outcome in OAC-ICH, but was independently associated with poor outcome in NON-OAC-ICH. The results underline the importance of etiology-specific treatment strategies. Further prospective studies are needed.
Nawabi et al. (Fri,) conducted a cohort in Intracerebral hemorrhage (n=811). Oral anticoagulants (OAC) vs. No oral anticoagulants (NON-OAC) was evaluated on Poor functional outcome (modified Rankin scale 4-6) predicted by absolute perihematomal edema (OR 1.02, 95% CI 1.002-1.028, p=0.027). Absolute perihematomal edema was an independent predictor of poor clinical outcome in NON-OAC-ICH (OR 1.02; 95% CI 1.002-1.028; p=0.027), but not in OAC-associated intracerebral hemorrhage (p=0.45).
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