J Stroke.
2017 Jan;19(1):67-76. 10.5853/jos.2016.00542.
Haemorrhagic Transformation after Ischaemic Stroke in Patients Taking Non-vitamin K Antagonist Oral Anticoagulants
- Affiliations
-
- 1Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany. r.veltkamp@imperial.ac.uk
- 2Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany.
- 3Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
- 4Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
- 5Department of Neurology, Tübingen University, Tübingen, Germany.
- 6Department of Neurology, University Hospital Münster, Germany.
- 7Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
- 8Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
- 9Department of Neurology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany.
- 10Comprehensive Heart Failure Center, and Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany.
- 11Department of Stroke Medicine, Imperial College London, London, United Germany.
- KMID: 2368403
- DOI: http://doi.org/10.5853/jos.2016.00542
Abstract
- BACKGROUND AND PURPOSE
To evaluate the frequency and outcome of haemorrhagic transformation (HT) after ischaemic stroke in patients treated with non-vitamin K antagonist oral anticoagulants (NOACs).
METHODS
Patients with stroke on treatment with a NOAC were prospectively enrolled in this multicentre observational study between February 2012 and 2015. Brain imaging at admission and follow-up imaging until day 7 were reviewed for HT. Functional outcome was assessed by the modified Rankin scale (mRS) before the index event, at discharge, and at 3-months.
RESULTS
231 patients without recanalisation therapy (no-RT), and 32 patients with RT were eligible for analysis. Any HT was present at admission in 9/231 no-RT patients (3.9%, 95% CI 2.0 to 7.3) and in none of the patients with RT. In patients with follow-up imaging (no-RT, n=129, and RT, n=32), HT was present in 14.0% (no-RT; 95% CI, 8.9 to 21.1), and 40.6% (RT, 95% CI, 25.5 to 57.8), respectively. After adjustment for stroke severity, this difference between the no-RT and RT groups became non-significant. Symptomatic ICH was observed in 1 patient per group. HT was not associated with unfavourable outcome (mRS 3-6) at 3-months in multivariable analysis. Resumption of OAC after stroke was delayed in patients with HT compared to those without (15 d [IQR, 5-26] vs. 1 d [0-4], P<0.001).
CONCLUSIONS
The frequency and severity of HT after stroke on NOAC appears similar to previous reports for vitamin K antagonists and no anticoagulation. Whether asymptomatic HT should delay resumption of preventive anticoagulation requires further investigation.
Keyword
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Adaptation of New Oral Anticoagulants for Warfarin Anticoagulated Patient with Traumatic Ongoing Hemorrhage
- Non-Vitamin K Oral Anticoagulants in Stroke Patients: Practical Issues
- New oral anticoagulants
- Stroke Prevention in Atrial Fibrillation
- 2018 Korean Heart Rhythm Society Guidelines for Non-Vitamin K Antagonist Oral Anticoagulants
