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23.08.2022 | Original Communication

Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants

verfasst von: Alvin S. Das, Elif Gökçal, Robert W. Regenhardt, Andrew D. Warren, Alessandro Biffi, Joshua N. Goldstein, W. Taylor Kimberly, Anand Viswanathan, Lee H. Schwamm, Jonathan Rosand, Steven M. Greenberg, M. Edip Gurol

Erschienen in: Journal of Neurology | Ausgabe 12/2022

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Abstract

Background and aims

Intracerebral hemorrhage (ICH) associated with direct oral anticoagulant (DOAC) usage confers significant mortality/disability. We aimed to understand the clinical and neuroimaging features associated with developing ICH among DOAC users.

Methods

Clinical and radiological data were collected from consecutive DOAC users with ICH (DOAC-ICH) and age-matched controls without ICH from a single referral center. The frequency/distribution of MRI markers of hemorrhage risk were assessed. Baseline demographics and neuroimaging markers were compared in univariate tests. Significant associations (p < 0.1) were entered into a multivariable regression model to determine predictors of ICH.

Results

86 DOAC-ICH and 94 ICH-free patients were included. Diabetes, coronary artery disease, prior ischemic stroke, smoking history, and antiplatelet usage were more common in ICH patients than ICH-free DOAC users. In the neuroimaging analyses, severe white matter hyperintensities (WMHs), lacunes, cortical superficial siderosis (cSS), and cerebral microbleeds (CMBs) were more common in the ICH cohort than the ICH-free cohort. In the multivariable regression, diabetes [OR 3.53 95% CI (1.05–11.87)], prior ischemic stroke [OR 14.80 95% CI (3.33–65.77)], smoking history [OR 3.08 95% CI (1.05–9.01)], CMBs [OR 4.07 95% CI (1.45–11.39)], and cSS [OR 39.73 95% CI (3.43–460.24)] were independently associated with ICH.

Conclusions

Risk factors including diabetes, prior stroke, and smoking history as well as MRI biomarkers including CMBs and cSS are associated with ICH in DOAC users. Although screening MRIs are not typically performed prior to initiating DOAC therapy, these data suggest that patients of high-hemorrhagic risk may be identified.

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Titel: Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants
verfasst von: Alvin S. Das
Elif Gökçal
Robert W. Regenhardt
Andrew D. Warren
Alessandro Biffi
Joshua N. Goldstein
W. Taylor Kimberly
Anand Viswanathan
Lee H. Schwamm
Jonathan Rosand
Steven M. Greenberg
M. Edip Gurol
Publikationsdatum: 23.08.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Neurology / Ausgabe 12/2022
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-022-11333-2

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