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October 7, 2023European Stroke JournalOpen Access

Impact of cerebral small vessel disease burden and drug level at admission on direct oral anticoagulant associated intracerebral hemorrhage

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Why the study?

DOAC-associated ICH is a catastrophic complication, but the impact of CT-based SVD burden on DOAC-ICH and admission DOAC concentrations on ICH outcomes required investigation.

Is cerebral small vessel disease burden and admission DOAC level associated with the risk and severity of intracerebral hemorrhage in DOAC users?

Population

43 DOAC-ICH patients and 177 DOAC-non-ICH patients

Comparison

DOAC-ICH patients vs stable DOAC-non-ICH patients and across admission DOAC drug levels

Design

Two-cohort study

Follow-up

3 months

Authors

SLShin‐Yi LinYCYa‐Fang ChenCCChih‐Hao Chen

Discussion

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Overview

Higher SVD burden was associated with DOAC-ICH and worse outcomes; leaves open whether CT-SVD scoring should inform anticoagulation decisions in AF.

Structured PICO

Is cerebral small vessel disease burden and admission DOAC level associated with the risk and severity of intracerebral hemorrhage in DOAC users?

P
Population
220 patients, comprising 43 patients with direct oral anticoagulant-associated intracerebral hemorrhage (DOAC-ICH) and 177 stable DOAC users who underwent head CT without ICH (DOAC-non-ICH).
I
Intervention
High cerebral small vessel disease (SVD) burden (evaluated by CT) and/or high DOAC concentration upon hospital admission (>300 ng/mL).
C
Comparator
Low SVD burden and/or stable DOAC users without ICH.
O
Outcome
Occurrence of DOAC-associated intracerebral hemorrhage (ICH).hard clinical

Higher cerebral small vessel disease burden and elevated admission DOAC levels are strongly associated with an increased risk and worse clinical outcomes of DOAC-associated intracerebral hemorrhage.

Limitations

  • Potential selection bias from using two distinct cohorts

Cite This Study

Lin et al. (2023) studied this question.

synapsesocial.com/papers/6a75fd2982bd1ced2778663bhttps://doi.org/10.1177/23969873231205673
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