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Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants

Background: There is a need to examine the effects of different types of oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) on perihematomal edema (PHE), which is gaining considerable appeal as a biomarker for secondary brain injury and clinical outcome. Methods: In a large multicenter...

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Autores principales: Nawabi, Jawed, Elsayed, Sarah, Morotti, Andrea, Speth, Anna, Liu, Melanie, Kniep, Helge, McDonough, Rosalie, Broocks, Gabriel, Faizy, Tobias, Can, Elif, Sporns, Peter B., Fiehler, Jens, Hamm, Bernd, Penzkofer, Tobias, Bohner, Georg, Schlunk, Frieder, Hanning, Uta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196746/
https://www.ncbi.nlm.nih.gov/pubmed/34063991
http://dx.doi.org/10.3390/jcm10112234
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author Nawabi, Jawed
Elsayed, Sarah
Morotti, Andrea
Speth, Anna
Liu, Melanie
Kniep, Helge
McDonough, Rosalie
Broocks, Gabriel
Faizy, Tobias
Can, Elif
Sporns, Peter B.
Fiehler, Jens
Hamm, Bernd
Penzkofer, Tobias
Bohner, Georg
Schlunk, Frieder
Hanning, Uta
author_facet Nawabi, Jawed
Elsayed, Sarah
Morotti, Andrea
Speth, Anna
Liu, Melanie
Kniep, Helge
McDonough, Rosalie
Broocks, Gabriel
Faizy, Tobias
Can, Elif
Sporns, Peter B.
Fiehler, Jens
Hamm, Bernd
Penzkofer, Tobias
Bohner, Georg
Schlunk, Frieder
Hanning, Uta
author_sort Nawabi, Jawed
collection PubMed
description Background: There is a need to examine the effects of different types of oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) on perihematomal edema (PHE), which is gaining considerable appeal as a biomarker for secondary brain injury and clinical outcome. Methods: In a large multicenter approach, computed tomography-derived imaging markers for PHE (absolute PHE, relative PHE (rPHE), edema expansion distance (EED)) were calculated for patients with OAC-ICH and NON-OAC-ICH. Exploratory analysis for non-vitamin-K-antagonist OAC (NOAC) and vitamin-K-antagonists (VKA) was performed. The predictive performance of logistic regression models, employing predictors of poor functional outcome (modified Rankin scale 4–6), was explored. Results: Of 811 retrospectively enrolled patients, 212 (26.14%) had an OAC-ICH. Mean rPHE and mean EED were significantly lower in patients with OAC-ICH compared to NON-OAC-ICH, p-value 0.001 and 0.007; whereas, mean absolute PHE did not differ, p-value 0.091. Mean EED was also significantly lower in NOAC compared to NON-OAC-ICH, p-value 0.05. Absolute PHE was an independent predictor of poor clinical outcome in NON-OAC-ICH (OR 1.02; 95%CI 1.002–1.028; p-value 0.027), but not in OAC-ICH (p-value 0.45). Conclusion: Quantitative markers of early PHE (rPHE and EED) were lower in patients with OAC-ICH compared to those with NON-OAC-ICH, with significantly lower levels of EED in NOAC compared to NON-OAC-ICH. Increase of early PHE volume did not increase the likelihood of poor outcome in OAC-ICH, but was independently associated with poor outcome in NON-OAC-ICH. The results underline the importance of etiology-specific treatment strategies. Further prospective studies are needed.
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spelling pubmed-81967462021-06-13 Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants Nawabi, Jawed Elsayed, Sarah Morotti, Andrea Speth, Anna Liu, Melanie Kniep, Helge McDonough, Rosalie Broocks, Gabriel Faizy, Tobias Can, Elif Sporns, Peter B. Fiehler, Jens Hamm, Bernd Penzkofer, Tobias Bohner, Georg Schlunk, Frieder Hanning, Uta J Clin Med Article Background: There is a need to examine the effects of different types of oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) on perihematomal edema (PHE), which is gaining considerable appeal as a biomarker for secondary brain injury and clinical outcome. Methods: In a large multicenter approach, computed tomography-derived imaging markers for PHE (absolute PHE, relative PHE (rPHE), edema expansion distance (EED)) were calculated for patients with OAC-ICH and NON-OAC-ICH. Exploratory analysis for non-vitamin-K-antagonist OAC (NOAC) and vitamin-K-antagonists (VKA) was performed. The predictive performance of logistic regression models, employing predictors of poor functional outcome (modified Rankin scale 4–6), was explored. Results: Of 811 retrospectively enrolled patients, 212 (26.14%) had an OAC-ICH. Mean rPHE and mean EED were significantly lower in patients with OAC-ICH compared to NON-OAC-ICH, p-value 0.001 and 0.007; whereas, mean absolute PHE did not differ, p-value 0.091. Mean EED was also significantly lower in NOAC compared to NON-OAC-ICH, p-value 0.05. Absolute PHE was an independent predictor of poor clinical outcome in NON-OAC-ICH (OR 1.02; 95%CI 1.002–1.028; p-value 0.027), but not in OAC-ICH (p-value 0.45). Conclusion: Quantitative markers of early PHE (rPHE and EED) were lower in patients with OAC-ICH compared to those with NON-OAC-ICH, with significantly lower levels of EED in NOAC compared to NON-OAC-ICH. Increase of early PHE volume did not increase the likelihood of poor outcome in OAC-ICH, but was independently associated with poor outcome in NON-OAC-ICH. The results underline the importance of etiology-specific treatment strategies. Further prospective studies are needed. MDPI 2021-05-21 /pmc/articles/PMC8196746/ /pubmed/34063991 http://dx.doi.org/10.3390/jcm10112234 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nawabi, Jawed
Elsayed, Sarah
Morotti, Andrea
Speth, Anna
Liu, Melanie
Kniep, Helge
McDonough, Rosalie
Broocks, Gabriel
Faizy, Tobias
Can, Elif
Sporns, Peter B.
Fiehler, Jens
Hamm, Bernd
Penzkofer, Tobias
Bohner, Georg
Schlunk, Frieder
Hanning, Uta
Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants
title Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants
title_full Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants
title_fullStr Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants
title_full_unstemmed Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants
title_short Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants
title_sort perihematomal edema and clinical outcome in intracerebral hemorrhage related to different oral anticoagulants
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196746/
https://www.ncbi.nlm.nih.gov/pubmed/34063991
http://dx.doi.org/10.3390/jcm10112234
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