Characteristics of intracerebral hemorrhage during rivaroxaban treatment: comparison with those during warfarin.

Abstract:

BACKGROUND AND PURPOSE:Neuroradiological characteristics and functional outcomes of patients with intracerebral hemorrhage (ICH) during novel oral anticoagulant treatment were not well defined. We examined these in comparison with those during warfarin treatment. METHODS:The consecutive 585 patients with ICH admitted from April 2011 through October 2013 were retrospectively studied. Of all, 5 patients (1%) had ICH during rivaroxaban treatment, 56 (10%) during warfarin, and the other 524 (89%) during no anticoagulants. We focused on ICH during rivaroxaban and warfarin treatments and compared the clinical characteristics, neuroradiological findings, and functional outcomes. RESULTS:Patients in the rivaroxaban group were all at high risk for major bleeding with hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS-BLED) score of 3 and higher rate of past history of ICH. Moreover, multiple cerebral microbleeds (≥4) were detected more frequently in rivaroxaban group than in warfarin (80% versus 29%; P=0.04). Hematoma volume in rivaroxaban group was markedly smaller than that in warfarin (median: 4 versus 11 mL; P=0.03). No patient in the rivaroxaban group had expansion of hematoma and surgical treatment. Rivaroxaban group showed lower modified Rankin Scale at discharge relative to warfarin, and the difference between modified Rankin Scale before admission and at discharge was smaller in rivaroxaban than in warfarin (median: 1 versus 3; P=0.047). No patient in the rivaroxaban group died during hospitalization, whereas 10 (18%) warfarin patients died. CONCLUSIONS:Rivaroxaban-associated ICH occurs in patients at high risk for major bleeding. However, they had a relatively small hematoma, no expansion of hematoma, and favorable functional and vital outcomes compared with warfarin-associated ICH.

journal_name

Stroke

journal_title

Stroke

authors

Hagii J,Tomita H,Metoki N,Saito S,Shiroto H,Hitomi H,Kamada T,Seino S,Takahashi K,Baba Y,Sasaki S,Uchizawa T,Iwata M,Matsumoto S,Osanai T,Yasujima M,Okumura K

doi

10.1161/STROKEAHA.114.006661

subject

Has Abstract

pub_date

2014-09-01 00:00:00

pages

2805-7

issue

9

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.114.006661

journal_volume

45

pub_type

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