Clinical short communicationThe prognostic utility of ICH-score in anticoagulant related intracerebral hemorrhage
Introduction
Even though the intracerebral hemorrhage (ICH) score provides a valid clinical grading scale that allows stratification on the probability of 30-day mortality for patients with ICH [1,2], this score has not been sufficiently validated in patients with ICH related to the use of oral anticoagulants (OAC-ICH), which are known to have a significantly higher mortality risk compared to ICH patients without history of OAC treatment [3]. A very recent systematic review and meta-analysis highlighted significant inconsistency in the prognostic utility of ICH-score between validation cohorts, suggesting that mortality is dependent on factors not included in the current version of the ICH score [4]. Anticoagulation is a predictor of hematoma expansion and mortality followiing ICH, but these risk are not uniform amongst different oral anticoagulants.
Taking into account that patients with ICH related to the use of non-vitamin K antagonist oral anticoagulants (NOAC-ICH) have smaller baseline hematoma volumes and less severe stroke syndromes compared to patients with ICH related to the use of vitamin K antagonists (VKA-ICH) [5], we sought to compare the performance of ICH score in the prognostication of 30-day mortality in NOAC-ICH and VKA-ICH.
Section snippets
Methods
We performed a post-hoc analysis of two prospective, international, multicenter, cohort studies of consecutive adult (≥18 years) patients with acute non-traumatic OAC-ICH. These cohorts are described in detail elsewhere [6,7]. In brief, VKA-ICH patients were required to be on current treatment with a VKA regiment and present on admission with an international normalized ratio (INR) value of >1.5, while NOAC-ICH patients should have confirmed intake of a NOAC the last 24 h before the ICH onset [6
Results
After excluding 8 patients with unavailable data on the exact time of death during follow-up, we included a total of 108 NOAC-ICH (dabigatran: 18, rivaroxaban: 47, apixaban: 43) and 241 VKA-ICH patients [median age: 76 years (IQR: 68–82), 58% men, median NIHSS score: 11 (4–21), median ICH-score: 2 (1–3)].
VKA-ICH patients had higher prevalence rates of chronic kidney disease (p = .006), increased neurological severity (p = .001) and more impaired consciousness on admission (p = .026) compared to
Discussion
Our study showed that ICH score can adequately predict 30-day mortality for ICH patients with history of oral anticoagulant intake, with possibly a more favorable yield for NOAC-ICH compared to VKA-ICH. Level of consciousness and ICH volume on admission emerged as two independent predictors of 30-day mortality in OAC-ICH on multivariable logistic regression models adjusting for potential confounders. Our observations are in line with a recent multicenter study reporting that the prognostic
Disclosures
None.
Acknowledgements
This work was partly presented as a Poster in the 5th European Stroke Organisation Conference, May 22-24, Milan, Italy.
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