Key result
Oral anticoagulant use in intracerebral hemorrhage was associated with increased risks of cerebellar location (RR 1.45; 95% CI 1.12-1.89) and intraventricular extension (RR 1.26; 95% CI 1.16-1.36).
Why the study?
Hematoma location and morphology of intracerebral hemorrhage associated with oral anticoagulants were evaluated to delineate causes and mechanisms.
Does oral anticoagulant use affect hematoma location and morphology in patients with intracerebral hemorrhage?
Meta-Analysis (n=6,259)
Does oral anticoagulant use affect hematoma location and morphology in patients with intracerebral hemorrhage?
Relative Risk: 1.45 (95% CI 1.12–1.89)
Absolute Event Rate: 10.4% vs 6.8%
p-value: p=0.005
Oral anticoagulant-associated intracerebral hemorrhage is characterized by a higher frequency of cerebellar location and intraventricular extension compared to non-OAC ICH.
OAC-ICH location patterns may aid etiology assessment; leaves open whether morphology informs management in observational data.
Objective To study hematoma location and morphology of intracerebral hemorrhage (ICH) associated with oral anticoagulants (OAC) and delineate causes and mechanism. Methods We performed a systematic literature research and meta-analysis of studies comparing neuroimaging findings in patients with OAC-ICH compared to those with ICH not associated with OAC (non-OAC ICH). We calculated pooled risk ratios (RRs) for ICH location using the Mantel-Haenszel random-effects method and corresponding 95% confidence intervals (95% CI). Results We identified 8 studies including 6,259 patients (OAC-ICH n = 1,107, pooled OAC-ICH population 17.7%). There was some evidence for deep ICH location (defined as ICH in the thalamus, basal ganglia, internal capsule, or brainstem) being less frequent in patients with OAC-ICH (OAC-ICH: 450 of 1,102/40.8% vs non-OAC ICH: 2,656 of 4,819/55.1%; RR 0.94, 95% CI 0.88–1.00, p = 0.05, I2 = 0%) while cerebellar ICH location was significantly more common in OAC-ICH (OAC-ICH: 111 of 1,069/10.4% vs non-OAC ICH: 326 of 4,787/6.8%; RR 1.45, 95% CI 1.12–1.89, p = 0.005, I2 = 21%) compared to non-OAC ICH. There was no statistically significant relationship to OAC use for lobar (OAC-ICH: 423 of 1,107/38.2% vs non-OAC ICH: 1,884 of 5,152/36.6%; RR 1.02, 95% CI 0.89–1.17, p = 0.75, I2 = 53%, p for heterogeneity = 0.04) or brainstem ICH (OAC-ICH: 36 of 546/6.6% vs non-OAC ICH: 172 of 2,626/6.5%; RR 1.04, 95% CI 0.58–1.87, p = 0.89, I2 = 59%, p for heterogeneity = 0.04). The risk for intraventricular extension (OAC-ICH: 436 of 840/51.9% vs non-OAC ICH: 1,429 of 3,508/40.7%; RR 1.26, 95% CI 1.16–1.36, p < 0.001, I2 = 0%) was significantly increased in patients with OAC-ICH. We found few data on ICH morphology in OAC-ICH vs non-OAC ICH. Conclusion The overrepresentation of cerebellar ICH location and intraventricular extension in OAC-ICH might have mechanistic relevance for the underlying arteriopathy, pathophysiology, or bleeding pattern of OAC-ICH, and should be investigated further.
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Seiffge et al. (2019) conducted a meta-analysis in Intracerebral hemorrhage (n=6,259). Oral anticoagulants (OAC) vs. No OAC (non-OAC ICH) was evaluated on Cerebellar ICH location (RR 1.45, 95% CI 1.12-1.89, p=0.005). Oral anticoagulant use in intracerebral hemorrhage was associated with increased risks of cerebellar location (RR 1.45; 95% CI 1.12-1.89) and intraventricular extension (RR 1.26; 95% CI 1.16-1.36).
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