Key Points
- To compare 90-day mortality, functional outcomes, baseline hematoma volume, and hematoma expansion between patients with non–vitamin K antagonist oral anticoagulant-related and vitamin K antagonist-associated intracerebral hemorrhage.
- Conducted an international multicenter pooled analysis of 500 patients (97 with NOAC-ICH and 403 with VKA-ICH).
- Evaluated 90-day all-cause mortality using a Cox proportional hazards model adjusted for age, sex, baseline Glasgow Coma Scale score, hematoma location/volume, intraventricular hemorrhage, and intracranial surgery.
- Assessed hematoma expansion (>33% or >6 mL increase within 72 hours) and good functional outcome (discharge modified Rankin Scale score ≤2) via multivariable logistic regression.
- 90-day all-cause mortality occurred in 33% of NOAC-ICH versus 31% of VKA-ICH patients (adjusted HR 0.93, 95% CI 0.52–1.64, p=0.79; unadjusted p=0.64).
- Median baseline ICH volume was 14.4 mL (IQR 3.6–38.4) for NOAC-ICH versus 10.6 mL (IQR 4.0–27.9) for VKA-ICH (p=0.78), with hematoma expansion observed in 40% (29/48) versus 34% (93/140), respectively (p=0.45).
- Good functional outcome at hospital discharge did not differ significantly between the groups (OR 0.47, 95% CI 0.18–1.19, p=0.11).
Structured PICO
Does NOAC-associated intracerebral hemorrhage have different mortality and functional outcomes compared to VKA-associated intracerebral hemorrhage?
PPopulation500 patients with oral anticoagulation-related intracerebral hemorrhage (ICH)
IInterventionNon-vitamin K antagonist oral anticoagulation (NOAC)
CComparatorVitamin K antagonist (VKA)
OOutcomeAll-cause mortality within 90 dayshard clinical
NOAC-associated intracerebral hemorrhage has similar baseline volume, hematoma expansion, 90-day mortality, and functional outcomes compared to VKA-associated intracerebral hemorrhage.