Key result
Vitamin K antagonist use in patients with intracerebral haemorrhage was associated with significantly higher in-hospital mortality compared to no oral anticoagulant use (OR 1.83).
Why the study?
Precise estimates of age, haematoma volume, secondary haematoma expansion, and mortality were needed for intracerebral haemorrhage patients taking oral anticoagulants compared to those not taking oral anticoagulants.
Does oral anticoagulant use prior to symptom onset worsen haematoma volume, expansion, and mortality in patients with intracerebral haemorrhage?
Meta-Analysis (n=150,270)
Yes
Does oral anticoagulant use prior to symptom onset worsen haematoma volume, expansion, and mortality in patients with intracerebral haemorrhage?
Vitamin K antagonist use prior to intracerebral hemorrhage is associated with larger hematoma volumes, increased hematoma expansion, and significantly higher in-hospital and 3-month mortality compared to no oral anticoagulation.
Objective To obtain precise estimates of age, haematoma volume, secondary haematoma expansion (HE) and mortality for patients with intracerebral haemorrhage (ICH) taking oral anticoagulants [Vitamin K antagonists (VKA-ICH) or non-Vitamin K antagonist oral anticoagulants (NOAC-ICH)] and those not taking oral anticoagulants (non-OAC ICH) at ICH symptom onset. Methods We conducted a systematic review and meta-analysis of studies comparing VKA-ICH or NOAC-ICH or both with non-OAC ICH. Primary outcomes were haematoma volume (in ml), HE, and mortality (in-hospital and 3-month). We calculated odds ratios (ORs) using the Mantel–Haenszel random-effects method and corresponding 95% confidence intervals (95%CI) and determined the mean ICH volume difference. Results We identified 19 studies including data from 16,546 patients with VKA-ICH and 128,561 patients with non-OAC ICH. Only 2 studies reported data on 4943 patients with NOAC-ICH. Patients with VKA-ICH were significantly older than patients with non-OAC ICH (mean age difference: 5.55 years, 95%CI 4.03–7.07, p < 0.0001, I 2 = 92%, p < 0.001). Haematoma volume was significantly larger in VKA-ICH with a mean difference of 9.66 ml (95%CI 6.24–13.07 ml, p < 0.00001; I 2 = 42%, p = 0.05). HE occurred significantly more often in VKA-ICH (OR 2.96, 95%CI 1.74–4.97, p < 0.00001; I 2 = 65%). VKA-ICH was associated with significantly higher in-hospital mortality (VKA-ICH: 32.8% vs. non-OAC ICH: 22.4%; OR 1.83, 95%CI 1.61–2.07, p < 0.00001, I 2 = 20%, p = 0.27) and 3-month mortality (VKA-ICH: 47.1% vs. non-OAC ICH: 25.5%; OR 2.24, 95%CI 1.52–3.31, p < 0.00001, I 2 = 71%, p = 0.001). We did not find sufficient data for a meta-analysis comparing NOAC-ICH and non-OAC-ICH. Conclusion This meta-analysis confirms, refines and expands findings from prior studies. We provide precise estimates of key prognostic factors and outcomes for VKA-ICH, which has larger haematoma volume, increased rate of HE and higher mortality compared to non-OAC ICH. There are insufficient data on NOACs.
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Seiffge et al. (2019) conducted a meta-analysis in Intracerebral haemorrhage (n=150,270). Vitamin K antagonists (VKA) vs. No oral anticoagulants (non-OAC) was evaluated on In-hospital mortality (OR 1.83, 95% CI 1.61-2.07, p=<0.00001). Vitamin K antagonist use in patients with intracerebral haemorrhage was associated with significantly higher in-hospital mortality compared to no oral anticoagulant use (OR 1.83).
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