Association of prothrombin complex concentrate administration and hematoma enlargement in non-vitamin K antagonist oral anticoagulant-related intracerebral hemorrhage

Journal article


Publication Details

Author(s): Gerner S, Kuramatsu JB, Sembill J, Sprügel M, Endres M, Haeusler KG, Vajkoczy P, Ringleb PA, Purrucker J, Rizos T, Erbguth F, Schellinger PD, Fink GR, Stetefeld H, Schneider H, Neugebauer H, Roether J, Classen J, Michalski D, Dörfler A, Schwab S, Huttner H
Journal: Annals of Neurology
Publication year: 2018
Volume: 83
Journal issue: 1
Pages range: 186-196
ISSN: 0364-5134


Abstract


To investigate parameters associated with hematoma enlargement in non-vitamin K antagonist oral anticoagulant (NOAC)-related intracerebral hemorrhage (ICH).This retrospective cohort study includes individual patient data for 190 patients with NOAC-associated ICH over a 5-year period (2011-2015) at 19 departments of neurology across Germany. Primary outcome was the association of prothrombin complex concentrate (PCC) administration with hematoma enlargement. Subanalyses were calculated for blood pressure management and its association with the primary outcome. Secondary outcomes include associations with in-hospital mortality and functional outcome at 3 months assessed using the modified Rankin Scale.The study population for analysis of primary and secondary outcomes consisted of 146 NOAC-ICH patients with available follow-up imaging. Hematoma enlargement occurred in 49/146 (33.6%) patients with NOAC-related ICH. Parameters associated with hematoma enlargement were blood pressure >= 160mmHg within 4 hours and-in the case of factor Xa inhibitor ICH-anti-Xa levels on admission. PCC administration prior to follow-up imaging was not significantly associated with a reduced rate of hematoma enlargement either in overall NOAC-related ICH or in patients with factor Xa inhibitor intake (NOAC: risk ratio [RR] = 1.150, 95% confidence interval [CI] = 0.632-2.090; factor Xa inhibitor: RR = 1.057, 95% CI = 0.565-1.977), regardless of PCC dosage given or time interval until imaging or treatment. Systolic blood pressure levels < 160mmHg within 4 hours after admission were significantly associated with a reduction in the proportion of patients with hematoma enlargement (RR = 0.598, 95% CI = 0.365-0.978). PCC administration had no effect on mortality and functional outcome either at discharge or at 3 months.In contrast to blood pressure control, PCC administration was not associated with a reduced rate of hematoma enlargement in NOAC-related ICH. Our findings support the need of further investigations exploring new hemostatic reversal strategies for patients with factor Xa inhibitor-related ICH. Ann Neurol 2018;83:186-196.



FAU Authors / FAU Editors

Dörfler, Arnd Prof. Dr.
Neuroradiologische Abteilung im Radiologischen Institut
Gerner, Stefan
Medizinische Fakultät
Huttner, Hagen Prof. Dr.
Medizinische Fakultät
Schwab, Stefan Prof. Dr.
Lehrstuhl für Neurologie
Sembill, Jochen
Medizinische Fakultät
Sprügel, Maximilian
Neurologische Klinik


External institutions with authors

Asklepios Kliniken
Charité - Universitätsmedizin Berlin
Johannes Wesling Klinikum Minden
Klinikum Nürnberg
Technische Universität Dresden
Universität Köln
Universität Leipzig
Universitätsklinikum Heidelberg
Universität Ulm


How to cite

APA:
Gerner, S., Kuramatsu, J.B., Sembill, J., Sprügel, M., Endres, M., Haeusler, K.G.,... Huttner, H. (2018). Association of prothrombin complex concentrate administration and hematoma enlargement in non-vitamin K antagonist oral anticoagulant-related intracerebral hemorrhage. Annals of Neurology, 83(1), 186-196. https://dx.doi.org/10.1002/ana.25134

MLA:
Gerner, Stefan, et al. "Association of prothrombin complex concentrate administration and hematoma enlargement in non-vitamin K antagonist oral anticoagulant-related intracerebral hemorrhage." Annals of Neurology 83.1 (2018): 186-196.

BibTeX: 

Last updated on 2019-19-09 at 07:11