Highlights
- •Intraparenchymal hemorrhage (IPH) is a feared complication of oral anticoagulation.
- •DOAC-IPH was not associated with increased mortality or hematoma expansion compared to VKA-IPH.
- •DOAC-IPH may be associated with a smaller hematoma volume as compared to VKA-IPH.
Abstract
Direct Oral Anticoagulants (DOAC) are increasingly used as an alternative to vitamin-K
antagonists (VKA) for anticoagulation and have shown lower rates of intracranial hemorrhage;
however, there is disagreement in the literature over the outcomes of the intraparenchymal
hemorrhages (IPH) associated with DOACs, and clinical concern regarding the lack of
standardized reversal strategies for DOACs. Thus, the aim of this meta-analysis was
to compare mortality, hematoma volume, and risk of hematoma expansion in patients
who developed an IPH on DOACs versus VKA. A systematic review of the literature was
conducted in accordance with the PRISMA guidelines. Studies were selected that reported
on mortality, hematoma expansion, and hematoma volume in DOAC-associated IPH. Pooled
risk ratios (RR) were calculated for mortality and hematoma expansion and pooled mean
difference (MD) was calculated for hematoma volume (ml) using random-effect models.
15 studies reporting on 1238 patients were included in the systematic review. Eleven
of these compared DOAC-IPH to VKA-IPH and were pooled quantitatively. DOAC-IPH was
not associated with increased mortality risk (RR: 0.95, 95%-CI: 0.72 –1.27) or increased
hematoma expansion risk (RR: 0.92; 95%-CI: 0.75–1.12) compared to VKA-IPH. The hematoma
volume of DOAC- IPH was statistically significantly smaller than VKA-IPH (MD: −12.14 ml;
95%-CI: −15.38; −8.89). In conclusion, DOAC-IPH was not associated with increased
mortality or hematoma expansion compared to VKA-IPH and may be associated with a smaller
hematoma volume.
Keywords
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Article info
Publication history
Published online: November 21, 2018
Accepted:
November 12,
2018
Received:
October 14,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
