gms | German Medical Science

Objective: Intracerebral haemorrhage (ICH) is the second most common cause of stroke. The risk of developing an ICH is 7-10 times higher under the treatment with anticoagulant drugs. On comparison with classical oral anticoagulant drugs (OACs), the treatment with new direct oral anticoagulant drugs (NOACs) has favorable characteristics regarding the risk profile and the patient compliance. Thus, NOACs are increasingly administrated. In consequence, ideal management of intracranial haemorrhage in patients being treated with NOACs is unknown and since a specific antidote is not known, the clinical course is expected to be more challenging. The aim of this study was to compare the clinical course of patients treated with different forms of oral anticoagulant drugs.

Method: The study is a retrospective observational study. Inclusion criteria were intracerebral haemorrhage volume > 10 ml and age > 18 years. Altogether 100 patients with spontaneous ICH were included (October 2012 to April 2015). Analyzed parameters included age, sex, NIHSS and GCS on admission, coagulation values, surgical management, modified ranking scale, Barthel index as well as Glasgow outcome scale at discharge. Four groups were categorized to compare the clinical course (NOACs, OACs, patients with impaired coagulation parameters (not including NOACs and OACs) and patients with regular coagulation parameters).

Results: In the final analysis 16 patients with NOACs are included as well as 21 with OACs and 23 with impaired coagulation (non – NOAC and OAC) as well as 40 patients with regular coagulation. Parameters displaying the clinical course (NIHSS at admission, ICH volume, complications, indication for surgery, correction of impaired coagulation, length of hospital stay) were not significantly different. Mortality in the NOAC, OAC and impaired coagulation groups was significantly higher when compared to patients with regular coagulation parameters. (p = 0.005) GOS and mortality was independent of correction of impaired coagulation. Furthermore patients with regular coagulation parameters had significantly better clinical outcome analyzing GOS at discharge (p = 0.04).

Conclusions: Our data indicates that the clinical course in patients with ICH and NOAC treatment is not different compared to patients with OAC treatment. Outcome and mortality were independent of correction of impaired coagulation. Overall mortality is higher in the patient subgroups with impaired coagulation compared to patients with regular coagulation parameters.