Key result
Oral anticoagulation was associated with significantly worse functional outcome at 3 months in intracerebral hemorrhage patients younger than 80 years (aOR 2.29), but not in those aged 80 years or older.
Why the study?
The study aimed to determine the influence of age on bleeding characteristics and clinical outcomes across primary spontaneous, VKA-related, and NOAC-related ICH.
Does prior oral anticoagulation worsen functional outcomes in patients with intracerebral hemorrhage across different age groups compared to non-anticoagulated patients?
Cohort (n=3,166)
Yes
Does prior oral anticoagulation worsen functional outcomes in patients with intracerebral hemorrhage across different age groups compared to non-anticoagulated patients?
Odds Ratio: 2.29 (95% CI 1.75–3)
Absolute Event Rate: 70.8% vs 56.6%
p-value: p=<0.001
Oral anticoagulation-related intracerebral hemorrhage is associated with worse functional outcomes compared to non-anticoagulated ICH in patients under 70 years, but this difference diminishes in older patients.
Age modifies OAC-related ICH outcomes, with worse function limited to patients <70; leaves open confirmation in prospective trials.
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.
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Sprügel et al. (2019) conducted a cohort in Intracerebral hemorrhage (n=3,166). Oral anticoagulation vs. No oral anticoagulation was evaluated on Unfavorable functional outcome (mRS 4-6) at 3 months in patients <80 years (aOR 2.29, 95% CI 1.75-3.00, p=<0.001). Oral anticoagulation was associated with significantly worse functional outcome at 3 months in intracerebral hemorrhage patients younger than 80 years (aOR 2.29), but not in those aged 80 years or older.
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