Article ; Online: Vitamin K antagonists but not non-vitamin K antagonists in addition on antiplatelet therapy should be associated with increase of hematoma volume and mortality in patients with intracerebral hemorrhage: A sub-analysis of PASTA registry study.
Journal of the neurological sciences
2023 Volume 448, Page(s) 120643
Abstract: Background and purpose: Prior concomitant use of vitamin K antagonists (VKAs) and antiplatelet (AP ... with intracranial hemorrhage (ICH). However, the prior concomitant use of non-vitamin K oral antagonists (NOACs) and AP has not ...
| Abstract | Background and purpose: Prior concomitant use of vitamin K antagonists (VKAs) and antiplatelet (AP) therapy increase the hematoma volume and mortality compared with VKA monotherapy in patients with intracranial hemorrhage (ICH). However, the prior concomitant use of non-vitamin K oral antagonists (NOACs) and AP has not been clarified. Methods: We conducted a PASTA registry study, which was an observational, multicenter, registry of 1043 patients with stroke receiving oral anticoagulants (OACs) in Japan. In the present study, ICH from the PASTA registry was used to analyze the clinical characteristics including mortality among the four groups (NOAC, VKA, NOAC and AP, and VKA and AP) using univariate and multivariate analyses. Results: Among the 216 patients with ICH, 118 (54.6%), 27 (12.5%), 55 (25.5%), 16 (7.4%) were taking NOAC monotherapy, NOAC and AP, VKA, and VKA and AP, respectively. In-hospital mortality rates were the highest in VKA and AP (31.3%) than in NOACs (11.9%), NOACs and AP (7.4%), and VKA (7.3%). Multivariate logistic regression analysis demonstrated that the concomitant use of VKA and AP (odds ratio [OR], 20.57; 95% confidence interval [CI], 1.75-241.75, p = 0.0162), initial National Institutes of Health Stroke Scale score (OR, 1.21; 95%CI, 1.10-1.37, p < 0.0001), hematoma volume (OR, 1.41; 95%CI, 1.10-1.90, p = 0.066), and systolic blood pressure (OR, 1.31; 95%CI, 1.00-1.75, p = 0.0422) were independently associated with in-hospital mortality. Conclusions: Although VKA in addition to AP therapy could increase the in-hospital mortality, NOAC and AP did not increase the hematoma volume, stroke severity, or mortality compared to NOAC monotherapy. |
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| MeSH term(s) | Humans ; Anticoagulants/adverse effects ; Platelet Aggregation Inhibitors/therapeutic use ; Administration, Oral ; Cerebral Hemorrhage/diagnostic imaging ; Cerebral Hemorrhage/drug therapy ; Cerebral Hemorrhage/chemically induced ; Hematoma/diagnostic imaging ; Hematoma/drug therapy ; Intracranial Hemorrhages/chemically induced ; Registries ; Fibrinolytic Agents/therapeutic use ; Stroke/diagnostic imaging ; Stroke/drug therapy ; Atrial Fibrillation/drug therapy |
| Chemical Substances | Anticoagulants ; Platelet Aggregation Inhibitors ; Fibrinolytic Agents |
| Language | English |
| Publishing date | 2023-04-01 |
| Publishing country | Netherlands |
| Document type | Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 80160-4 |
| ISSN | 1878-5883 ; 0022-510X ; 0374-8642 |
| ISSN (online) | 1878-5883 |
| ISSN | 0022-510X ; 0374-8642 |
| DOI | 10.1016/j.jns.2023.120643 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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