***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Intracranial hemorrhage is the most devastating complication of anticoagulation . Outcomes associated with different sites of intracranial bleeding occurring with warfarin versus dabigatran have not been defined . Methods — Analysis of 18 113 participants with atrial fibrillation in the R and omized Evaluation of Long-term anticoagulant therapY ( RE-LY ) trial assigned to adjusted-dose warfarin ( target international normalized ratio , 2–3 ) or dabigatran ( 150 mg or 110 mg , both twice daily ) . Results — During a mean of 2.0 years of follow-up ,  154 intracranial hemorrhages occurred in 153 participants : 46 % intracerebral ( 49 % mortality ) , 45 % subdural ( 24 % mortality ) , and 8 % subarachnoid ( 31 % mortality ) . The rates of intracranial hemorrhage were 0.76 % , 0.31 % , and 0.23 % per year among those assigned to warfarin , dabigatran 150 mg , and dabigatran 110 mg , respectively ( P<0.001 for either dabigatran dose versus warfarin ) . Fewer fatal intracranial hemorrhages occurred among those assigned dabigatran 150 mg and 110 mg ( n=13 and n=11 , respectively ) versus warfarin ( n=32 ; P<0.01 for both ) . Fewer traumatic intracranial hemorrhages occurred among those assigned to dabigatran ( 11 patients with each dose ) compared with warfarin ( 24 patients ; P<0.05 for both dabigatran doses versus warfarin ) . Independent predictors of intracranial hemorrhage were assignment to warfarin ( relative risk , 2.9 ; P<0.001 ) , aspirin use ( relative risk , 1.6 ; P=0.01 ) , age ( relative risk , 1.1 per year ; P<0.001 ) , and previous stroke/transient ischemic attack ( relative risk , 1.8 ; P=0.001 ) . Conclusions — The clinical spectrum of intracranial hemorrhage was similar for patients given warfarin and dabigatran . Absolute rates at all sites and both fatal and traumatic intracranial hemorrhages were lower with dabigatran than with warfarin . Concomitant aspirin use was the most important modifiable independent risk factor for intracranial hemorrhage BACKGROUND Warfarin sodium is highly effective for prevention of embolic stroke , particularly in nonvalvular atrial fibrillation , but its expected benefit can be offset by risk of intracerebral hemorrhage ( ICH ) . We studied the determinants of ICH outcome to quantify the independent effect of warfarin . METHODS Consecutive patients with supratentorial ICH treated in a tertiary care hospital with a neurointensive care unit were prospect ively identified during a 7-year period , and data on hemorrhage location , clinical characteristics , and warfarin use were collected . Independent predictors of 3-month mortality were determined using multiple logistic regression analysis . RESULTS Of 435 consecutive patients aged 55 years or older , 102 ( 23.4 % ) were taking warfarin at the time of ICH .  Three-month mortality was 25.8 % for those not taking warfarin and 52.0 % for those taking warfarin . Independent predictors of death were warfarin use ( odds ratio [ OR ] , 2.2 ; 95 % confidence interval [ CI ] , 1.3 - 3.8 ) , age 70 years or older ( OR , 2.4 ; 95 % CI , 1.4 - 4.0 ) , and presence of diabetes mellitus ( OR , 1.8 ; 95 % CI , 1.0 - 3.3 ) . Although 68.0 % of all warfarin-related hemorrhages occurred at an international normalized ratio ( INR ) of 3.0 or less , increasing degrees of anticoagulation were strongly associated with increasing risk of death compared with no warfarin use . CONCLUSIONS Patients taking warfarin  had a doubling in the rate of intracerebral hemorrhage mortality in a dose-dependent manner . The data suggest that careful control of the INR , already known to limit the risk of warfarin-related ICH , may also limit its severity Objectives The first non-vitamin K antagonist oral anticoagulant ( NOAC ) introduced to the market in Japan was dabigatran in March 2011 , and three more NOACs , rivaroxaban , apixaban , and edoxaban , have since become available . R and omized controlled trials of NOACs have revealed that intracranial hemorrhage ( ICH ) occurs less frequently with NOACs compared with warfarin . However , the absolute incidence of ICH associated with NOACs has increased with greater use of these anticoagulants , and we wanted to explore the incidence , clinical characteristics , and treatment course of patients with NOACs-associated ICH . Methods We retrospectively analyzed the characteristics of symptomatic ICH patients receiving NOACs between March 2011 and September 2014 . Results ICH occurred in 6 patients ( 5 men , 1 woman ; mean ± SD age , 72.8 ± 3.2 years )  . Mean time to onset was 146.2 ± 111.5 days after starting NOACs . Five patients received rivaroxaban and 1 patient received apixaban . None received dabigatran or edoxaban .  Notably , no hematoma expansion was observed within 24 h of onset in the absence of infusion of fresh frozen plasma , activated prothrombin complex concentrate , recombinant activated factor VIIa or hemodialysis . When NOAC therapy was initiated , mean HAS-BLED and PANWARDS scores were 1.5 ± 0.5 and 39.5 ± 7.7 , respectively . Mean systolic blood pressure was 137.8 ± 15.9 mmHg within 1 month before spontaneous ICH onset . Conclusion Six symptomatic ICHs occurred early in NOAC therapy but hematoma volume was small and did not exp and in the absence of infusion of reversal agents or hemodialysis . The occurrence of ICH during NOAC therapy is possible even when there is acceptable mean systolic blood pressure control ( 137.8 ± 15.9 mmHg ) and HAS-BLED score ≤ 2 . Even stricter blood pressure lowering and control within the acceptable range may be advisable to prevent ICH during NOAC therapy Background : Hematoma expansion ( HE ) is a surrogate marker in intracerebral hemorrhage ( ICH ) trials . However , the amount of HE necessary to produce poor outcomes in an individual is unclear ; there is no agreement on a clinical ly meaningful definition of HE . We compared commonly used definitions of HE in their ability to predict poor outcome as defined by various cutpoints on the modified Rankin Scale ( mRS ) . Methods : In this cohort study , we analyzed 531 patients with ICH from the Virtual International Stroke Trials Archive . Primary outcome was mRS at 90 days , dichotomized into 0–3 vs 4–6 . Secondary outcomes included other mRS cutpoints and mRS “ shift analysis . ” Sensitivity , specificity , and predictive values for commonly used HE definitions were calculated . Results : Between 13 % and 32 % of patients met the commonly used HE definitions . All definitions independently predicted poor outcome ; positive predictive values increased with higher growth cutoffs but at the expense of lower sensitivities . All HE definitions showed higher specificity than sensitivity . Absolute growth cutoffs were more predictive than relative cutoffs when mRS 5–6 or 6 was defined as “ poor outcome . ” Conclusion : HE robustly predicts poor outcome regardless of the growth definition or the outcome definition . The highest positive predictive values are obtained when using an absolute growth definition to predict more severe outcomes . Given that only a minority of patients may have clinical ly relevant HE , hemostatic ICH trials may need to enroll a large number of patients , or select for a population that is more likely to have HE Background : Patients undergoing anticoagulation therapy  often experience  intracerebral hemorrhages ( ICHs )  , and warfarin in particular is known to increase hematoma expansion in ICHs , which results in a poor outcome . Recent studies reported that , in comparison with warfarin , direct oral anticoagulants ( DOACs ) cause fewer ICHs with better functional outcome . However , since it is still unknown whether DOACs are associated with a smaller hematoma volume of ICHs , we aim ed to compare the volume , hematoma expansion , and outcomes associated with ICHs treated with DOACs and warfarin . Methods : We performed a prospect i ve multicenter cross-sectional study . The subjects included patients with acute ICHs who received either DOACs or warfarin .  We evaluated the clinical characteristics , and measured initial and follow-up ICH volumes . The volume of ICHs and hematoma expansion were compared between the DOAC and warfarin groups . Mortality and modified Rankin score at discharge were evaluated as outcomes . Results : There were 18 patients in the DOAC group and 71 in the warfarin group . The baseline characteristics were similar between the 2 groups . Initial median hematoma volume of ICHs in the DOAC group was significantly lower than that in the warfarin group ( 6.2 vs. 24.2 mL , respectively ; p = 0.04 ) . In cases involving follow-up computed tomography scanning , the median hematoma volume of ICHs at follow-up was lower in the DOAC group than in the warfarin group ( initial : DOACs 4.4 vs. warfarin 13.5 mL ; follow-up : 5.0 vs. 18.4 mL , respectively ; p = 0.05 ) . Further , the hematoma in ICHs associated with DOACs did not exp and . Although the mortality of ICHs associated with DOACs ( 11 % ) was lower than that associated with warfarin ( 24 % ) , this difference was not statistically significant . The univariate analysis showed that the anticoagulant type ( DOACs vs. warfarin ) and sex ( male vs. female ) were associated with ICH volume . The multivariable linear regression showed that the use of DOACs ( compared to warfarin ; β : –0.23 , p = 0.03 ) and female sex ( compared to male ; β : –0.25 , p = 0.02 ) were associated with a small hematoma volume . Conclusions : Based on the results of the present study , in terms of the risks associated with ICHs , the use of DOACs appears to be safer than warfarin for anticoagulation therapy . Further studies are required to vali date these findings Background and Purpose Anticoagulant-associated intracranial hemorrhage ( aaICH ) presents with larger hematoma volumes , higher risk of hematoma expansion , and worse outcome than spontaneous intracranial hemorrhage . Prothrombin complex concentrates ( PCCs ) are indicated for urgent reversal of anticoagulation after aaICH . Given the lack of r and omized controlled trial evidence of efficacy , and the potential for thrombotic complications , we aim ed to determine outcomes in patients with aaICH treated with PCC .  Methods We conducted a prospect i ve multicenter registry of patients treated with PCC for aaICH in Canada . Patients were identified by local blood banks after the release of PCC .  A chart review abstract ed clinical , imaging , and laboratory data , including thrombotic events after therapy . Hematoma volumes were measured on brain CT scans and primary outcomes were modified Rankin Scale at discharge and in-hospital mortality . Results Between 2008 and 2010 , 141 patients received PCC for aaICH ( 71 intraparenchymal hemorrhages ) . The median age was 78 years ( interquartile range , 14 ) , 59.6 % were male , and median Glasgow Coma Scale was 14 .  Median international normalized ratio was 2.6 ( interquartile range , 2.0 ) and median parenchymal hematoma volume was 15.8 mL ( interquartile range , 31.8 ) . Median post-PCC therapy international normalized ratio was 1.4 : 79.5 % of patients had international normalized ratio correction ( < 1.5 ) within 1 hour of PCC therapy . Patients with intraparenchymal hemorrhage had an in-hospital mortality rate of 42.3 % with median modified Rankin Scale of 5 . Significant hematoma expansion occurred in 45.5 % . There were 3 confirmed thrombotic complications within 7 days of PCC therapy . Conclusions PCC therapy rapidly corrected international normalized ratio in the majority of patients , yet mortality and morbidity rates remained high . Rapid international normalized ratio correction alone may not be sufficient to alter prognosis after aaICH Background and Purpose — In r and omized trials , patients with atrial fibrillation ( AF ) receiving dabigatran , a direct oral anticoagulant  , had lower risk of intracranial bleeding ( ICB ) than those on  warfarin . However , concerns exist about potential worse outcomes in dabigatran users if bleeding occurs , given the lack of approved reversal agents . Thus , we examined in-hospital mortality in AF patients with ICB being treated with dabigatran versus warfarin in a real-world population in the United States . Methods — We analyzed healthcare utilization cl aims in the Truven Health Marketscan Research Data bases . The study sample included patients with AF admitted to a hospital with a primary diagnosis of ICB . Information on medications , inpatient , and outpatient diagnoses was obtained from available cl aims . Propensity score – adjusted risk ratios and 95 
    Output:
    
Conclusion Our results confirm that ICH volume , haematoma expansion , mortality and functional outcome appear to be similar for NOAC-ICH versus VKA-ICH .