Neuroimaging characteristics and clinical outcomes in functionally independent patients presenting with oral anticoagulant related nontraumatic intracerebral hemorrhage

Background and Aims: We have previously reported smaller hematoma volume and lesser presenting neurologic deficits in patients with intracerebral hemorrhage (ICH) due to direct oral anticoagulants (DOACs) as compared to vitamin K antagonists (VKA). We sought to prospectively validate our findings in functionally independent patients prior to index event. Method: We prospectively evaluated clinical, laboratory and imaging data from consecutive patients with non-traumatic, anticoagulation-related ICH admitted at 15 tertiary stroke care centers over a 12-month period. Results: Our cohort comprised 196 ICH patients: 62 DOAC-related (mean age 75.0±11.4 years, 54.8% men) and 134 VKA-related (mean age 72.3±10.5 years, 73.1% men). There were no differences in vascular comorbidities, HAS-BLED, CHA2DS2-VASc scores, antiplatelet and statin use; VKA-related ICH were more likely to be lobar (60.4% vs 32.2%, p10) (37% vs 55.3%, p=0.025). VKA-ICH had higher median 24-hr hematoma volume (20.0 [6.8-59] vs 15.9 [2.5-32.7] ml, p=0.02) and were more likely to have significant hematoma expansion (37.4% vs 17%, p=0.008) and midline shift (47 vs 36%, p=0.03) at 24hrs. Pretreatment with DOACs was independently associated with smaller baseline hematoma volume and lower likelihood of severe neurological deficits in multivariable models adjusting for potential confounders. Conclusion:We confirmed our previous findings in a prospective, multicenter cohort of functionally independent ICH patients. Patients with DOAC-related ICH have smaller baseline hematoma volume and lower odds of severe neurological deficits compared to VKA-related ICH