Haemorrhagic Transformation after Ischaemic Stroke in Patients Taking Non-vitamin K Antagonist Oral Anticoagulants.
- Author:
Jan C. PURRUCKER
1
;
Kirsten HAAS
;
Marcel WOLF
;
Timolaos RIZOS
;
Shujah KHAN
;
Peter KRAFT
;
Sven POLI
;
Rainer DZIEWAS
;
Johannes MEYNE
;
Frederick PALM
;
Sebastian JANDER
;
Markus MÖHLENBRUCH
;
Peter U. HEUSCHMANN
;
Roland VELTKAMP
Author Information
- Publication Type:Original Article
- Keywords: Stroke; Anticoagulation; Haemorrhagic Transformation
- MeSH: Anticoagulants*; Follow-Up Studies; Humans; Neuroimaging; Observational Study; Prospective Studies; Stroke*; Vitamin K
- From:Journal of Stroke 2017;19(1):67-76
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND PURPOSE: To evaluate the frequency and outcome of haemorrhagic transformation (HT) after ischaemic stroke in patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). METHODS: Patients with stroke on treatment with a NOAC were prospectively enrolled in this multicentre observational study between February 2012 and 2015. Brain imaging at admission and follow-up imaging until day 7 were reviewed for HT. Functional outcome was assessed by the modified Rankin scale (mRS) before the index event, at discharge, and at 3-months. RESULTS: 231 patients without recanalisation therapy (no-RT), and 32 patients with RT were eligible for analysis. Any HT was present at admission in 9/231 no-RT patients (3.9%, 95% CI 2.0 to 7.3) and in none of the patients with RT. In patients with follow-up imaging (no-RT, n=129, and RT, n=32), HT was present in 14.0% (no-RT; 95% CI, 8.9 to 21.1), and 40.6% (RT, 95% CI, 25.5 to 57.8), respectively. After adjustment for stroke severity, this difference between the no-RT and RT groups became non-significant. Symptomatic ICH was observed in 1 patient per group. HT was not associated with unfavourable outcome (mRS 3-6) at 3-months in multivariable analysis. Resumption of OAC after stroke was delayed in patients with HT compared to those without (15 d [IQR, 5–26] vs. 1 d [0–4], P<0.001). CONCLUSIONS: The frequency and severity of HT after stroke on NOAC appears similar to previous reports for vitamin K antagonists and no anticoagulation. Whether asymptomatic HT should delay resumption of preventive anticoagulation requires further investigation.
