Age dependent clinical outcomes in primary versus oral anticoagulation related intracerebral hemorrhage
Aims This study determined the influence of age on bleeding characteristics and clinical outcomes in primary spontaneous (non OAC) vitamin K antagonist related (VKA and non vitamin K antagonist oral anticoagulant related (NOAC ICH. Methods Pooled individual patient data of multicenter cohort studies were analyzed by logistic regression modelling and propensity score matching (PSM) to explore the influence of advanced age on clinical outcomes among non OAC VKA and NOAC ICH. Primary outcome measure was functional outcome at three months assessed by the modified Rankin Scale, dichotomized into favorable (mRS 0 3) and unfavorable (mRS 4 6) functional outcome. Secondary outcome measures included mortality, hematoma characteristics, and frequency of invasive interventions. Results In VKA ICH 33.5% (670/2001) in NOAC ICH 44.2% (69/156) and in non OAC ICH 25.2% (254/1009) of the patients were =80 years. After adjustment for treatment interventions and relevant parameters, elderly ICH patients comprised worse functional outcome at three months (adjusted odds ratio (aOR) in VKA ICH: 1.49 (1.21 1.84) p 0.001; NOAC ICH: 2.01 (0.95 4.26) p 0.069; non OAC ICH: 3.54 (2.50 5.03) p 0.001) Anticoagulation was significantly associated with worse functional outcome below the age of 70 years, (aOR: 2.38 (1.78 3.16) p 0.001) but not in patients of =70 years (aOR: 1.21 (0.89 1.65) p 0.217) The differences in initial ICH volume and extent of ICH enlargement between OAC ICH and non OAC ICH gradually decreased with increasing patient age. Conclusions As compared to elderly ICH patients, in patients <70 years OAC ICH showed worse clinical outcomes compared to non OAC ICH because of larger baseline ICH volumes and extent of hematoma enlargement. Treatment strategies aiming at neutralizing altered coagulation should be aware of these findings.
International journal of stroke official journal of the International Stroke Society