Prognostic factors and analysis of mortality due to brain haemorrhages associated with vitamin K antagonist oral anticoagulants. Results from the TAC registry

Neurologia (Engl Ed). 2018 Sep;33(7):419-426. doi: 10.1016/j.nrl.2016.07.005. Epub 2016 Sep 16.
[Article in English, Spanish]

Abstract

Introduction: Intracranial haemorrhages (ICH) represent a severe and frequently lethal complication in patients treated with vitamin K antagonists (VKA). The purpose of our study is to describe the factors and clinical features associated with mortality in these patients.

Methods: We conducted an observational, retrospective, multi-centre study based on prospective stroke registries in Spain. We included all patients admitted to neurology departments during a one-year period who met the following inclusion criteria: being 18 or older, having a diagnosis of ICH, and receiving VKA. Clinical and radiological parameters and 3-month outcomes were analysed.

Results: A total of 235 patients from 21 hospitals were included. Mortality rate at 90 days was 42.6%. Bivariate analysis showed a significant association between death and the following factors: median NIHSS score at admission (5 [IQR = 9] vs 17 [IQR = 14] points, P<.01) and presence of an extensive hemispheric haemorrhage (4.9% vs 35%, P < .01; χ2). Extensive hemispheric haemorrhages, in addition to being the most lethal type, were associated with a shorter time to death (mean of 16.5 days; 95% CI: 7.1-26). A logistic regression model showed that only baseline NIHSS scores independently predicted death (odds ratio=1.13 [95% CI: 1.08-1.17] for each point in the scale).

Conclusion: ICH in patients treated with VKA is associated with high mortality rates; mortality in these patients is mainly and independently associated with the clinical situation at stroke onset.

Keywords: Acenocoumarol; Acenocumarol; Anticoagulantes orales; Hemorragia cerebral; Intracranial haemorrhage; Mortalidad; Mortality; Oral anticoagulants; Warfarin; Warfarina.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Cause of Death
  • Cerebral Hemorrhage / chemically induced*
  • Cerebral Hemorrhage / mortality*
  • Female
  • Humans
  • Middle Aged
  • Prognosis
  • Registries
  • Retrospective Studies
  • Spain / epidemiology
  • Stroke / complications
  • Vitamin K / antagonists & inhibitors*
  • Young Adult

Substances

  • Anticoagulants
  • Vitamin K